For Referrers ~ 24-hr Consent Form

Ohio law requires that any woman seeking an abortion meet with a licensed physician at least 24 hours before her procedure for a face-to-face consultation. This means women must make two visits to the clinic.

However, according to the law, any licensed physician can provide the face-to-face consultation. Below are PDF files of the script of the information that needs to be covered and an Outside Provider Consent Verification form to help you expedite your patient’s abortion care.

Please fill out the forms completely and fax them to Preterm at 216.991.4571 or scan and email them to us at info@preterm.org.

Physician Script for 24-hr Consent (opens as PDF)

Outside Provider Consent Form (opens as PDF)