Patient Statement

Print Out and Sign at Least 24 Hours in Advance of Procedure

The law requires that you certify that you have had access to the materials outlined in the Women’s Right To Know Act at least 24 hours before an abortion procedure. So you will need to:

 

I, ____________________________________________________________________________________,
(signature)

acknowledge that I have had the opportunity to review either online or in printed form the information at DHEC’s “Information Outlined in the S.C. Women’s Right to Know Act” website, as specified in the S.C. Women’s Right to Know Act.

Print Name: ___________________________________________________________________________

Date / Time: ______________________________________

Printed: