24-Hr Required Information

Legal Requirement

Download, print, sign with date and time, and bring with you this PDF of the PATIENT ACKNOWLEDGEMENT OF 24 HOUR NOTIFICATION, State of Georgia Requirement.” (Must be completed at least 24 hours prior to your scheduled appointment.)

Women’s Right To Know Act

A law in the State of Georgia requires us to provide you with information they have put together regarding full term pregnancy and abortion at least 24 hours prior to your procedure. Once you have read this information you MUST contact the office in order to finalize your appointment.

The required information is:

I.   The probable Gestational Age of the embryo/fetus at the time of the abortion, estimated from the LMP, is _____ weeks. (Click for the pregnancy calculator.) All abortions performed here are below 17 weeks.
II. Some of the immediate medical risks associated with the particular abortion procedure that will be used to end the pregnancy include:

SURGICAL

  1. Pelvic Infection
  2. Incomplete Abortion
  3. Heavy Bleeding
  4. Cut or torn cervix
  5. Perforation of the wall of the Uterus
  6. Anesthesia related complications.

MEDICAL

  1. Infection and Fever
  2. Incomplete Abortion
  3. Painful Cramping
  4. Heavy Vaginal Bleeding
  5. Allergic reaction to the medication
  6. Nausea, vomiting or diarrhea
  7. Continued pregnancy and birth defects

III. Some of the general medical risks associated with continuing the pregnancy to full term are:

  1. Preeclampsia
  2. Stroke
  3. Diabetes
  4. Uterine Infection
  5. Heavy Blood Loss
  6. Post-partum depression
  7. Complications during labor and delivery
  8. Anesthesia related complications.

IV.   Medical assistance benefits may be available for prenatal care, childbirth and newborn care.

V.    If you continue the pregnancy to full term the father will have a legal responsibility to provide for the support of the child.

VI.   Upon request, you have the right to review the printed or online materials that have been provided by the state of Georgia that describe the fetus and lists agencies that offer alternatives to abortion.