I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.  My frame was not hidden from you when I was made in the secret place.  When I was woven together in the depths of the earth, your eyes saw my unformed body.  All the days ordained for me were written in your book before one of them came to be.  Psalm 139:14-16

...for the woman who is seeking a legal abortion:    Printable version

Know Your Legal Rights!

YOU HAVE THE RIGHT...

1. to insist that your abortion is performed by a licensed physician.
2. to know if this physician has ever had his or her medical license suspended.
3. to know if this physician has a history of claims for medical malpractice.
4. to verify that this physician has medical malpractice insurance in case you are injured or killed during the procedure.
5. to insist that if you are injured during the procedure you are immediately transferred by ambulance to the nearest emergency hospital or trauma center.

Against Your Will?

Regardless of your age, marital status or other circumstances, if someone is trying to force you to have an abortion, call:

1-800-401-6494

WARNINGS

If you are injured during your abortion, even if you signed a statement saying you would not hold the clinic or doctor responsible, call:

1-800-401-6494

_______________________________________________________________________
Name

_______________________________________________________________________
Name of facility where procedure will be performed

_______________________________________________________________________
City and State where facility is located

_______________________________________________________________________
Name of Malpractice Insurance Company

_______________________________________________________________________
State where Insurance Company is located

_______________________________________________________________________
Policy Number

_________________________            ________________________________________
Policy Limit                                        Date of Expiration

_______________________________________________________________________
Name of nearest trauma center or emergency hospital

_______________________________________________________________________
Location of this trauma center or emergency hospital

I certify that the information above is true and accurate and that: (a) I am a physician licensed to practice medicine in the state where this abortion is to be performed, (b) I have a current and fully paid medical malpractice insurance policy with the company named above, (c) my license to practice medicine has never been suspended or revoked in this or any other state, (d) I have no claims or judgments against me for medical malpractice, personal injury or wrongful death, and (e) if you are injured during your abortion you will be immediately transferred by ambulance to the emergency facility named above.

_________________________            ________________________________________
Physician's signature                        Date

Printable version

From a pamphlet produced by:
Life Dynamics Incorporated
PO Box 2226Denton, Texas  76202
(940) 380-8800fax (940) 380-8700

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Last modified: 04/29/08