Camelback Family Planning patient forms

Save time by downloading, printing out, completing forms, and bringing them with you to your appointment.

Patient Forms

To reduce the amount of time spent at your appointment, download the appropriate FORMS, print, complete and bring them with you.

Arizona Abortion Law Requirement

You must meet with the doctor at the office at least 24 hours prior to obtaining an abortion. This law does require an extra appointment. We will also be doing a pregnancy test, an ultrasound, and checking blood type and hemoglobin for anemia.  Fees for the testing services are $100 and may be collected on the day services are rendered.

Must Read: State of Arizona medical abortion mandate or the State of Arizona surgical abortion mandate information the doctor will be reviewing with you.

At least 24 hours prior to having your abortion, you will need to review the above state mandated information about your abortion in person with the doctor.

Please be sure to read about the different methods. Once you have determined which type of abortion you plan to have, please call the office to schedule your state-mandated with the doctor.

Do not hesitate to call our office for additional information or help obtaining these forms.


NOTE: The following FORMS are made available to you online in Adobe Acrobat Reader. Please access www.adobe.com for a FREE download.

PDF for Camelback Family Planning Surgical Abortion Consent form
PDF for Camelback Family Planning Medical Abortion Consent form
PDF for Camelback Family Planning Health History form
PDF for Camelback Family Planning Patient Registration form
PDF for Camelback Family Planning Depo-Provera Consent form
PDF for Camelback Family Planning Credit Card Authorization form

 


If you are UNDER the age of 18, you must have parental consent. Please download the form, complete both pages, have it notarized and bring to your appointment:

PDF for Camelback Family Planning Minor Consent form

If you feel you cannot tell your parent or guardian, you will need a judicial bypass. Please call the office so we can help you.


If you are having a 2 day procedure, you will need the following consent form instead of the surgical consent form above:

PDF for Camelback Family Planning Laminaria Consent form

 

ESPANOL FORMS

En orden para reducir el tiempo que gastas en tu cita, por favor copia las formas, grabado, complete y necessitas traer las formas contigo a tu cita.

Nota: Las formas son disponible para usted en la Internet Adobe Acrobat Reader www.adobe.com

Formas de:

PDF for Camelback Family Planning Consento de Informacion para Terminacion de Embarazo (Aborto)
PDF for Camelback Family Planning Consento de Aborto Medical (Mifeprex y Misoprostol)

 

  • hank you for making this difficult decision easier. You were all so caring, loving and down to earth.
    Your kindness will not be forgotten. As for me, I am 34 and have 4 children already.
    I pray for forgiveness from God and will now begin the healing process. Remember we are never alone. – -K

  • hank you for making this difficult decision easier. You were all so caring, loving and down to earth.
    Your kindness will not be forgotten. As for me, I am 34 and have 4 children already.
    I pray for forgiveness from God and will now begin the healing process. Remember we are never alone. – -K

  • hank you for making this difficult decision easier. You were all so caring, loving and down to earth.
    Your kindness will not be forgotten. As for me, I am 34 and have 4 children already.
    I pray for forgiveness from God and will now begin the healing process. Remember we are never alone. – -K

  • hank you for making this difficult decision easier. You were all so caring, loving and down to earth.
    Your kindness will not be forgotten. As for me, I am 34 and have 4 children already.
    I pray for forgiveness from God and will now begin the healing process. Remember we are never alone. – -K