• Watch the required abortion information video here

  • Pennsylvania state law says we must share some important information with you before your visit. Please watch the short video below. You must watch the entire 8-minute video at normal speed. Once the video ends, a "next" button will pop up. Click that button to sign a form that proves you finished watching.

    What you need to do:

    • Watch the full 8-minute video.
    • Do not speed up the video.
    • Wait for the "next" button to appear.
    • Fill out and sign the online form.
    • This screen lets you know your form is finished:

  • Pregnancy dating calculator 

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • My signature below indicates that I watched the Abortion Control Act Infomed Consent video completely at the date and time listed. I understand that I have the option to request to speak to a physician at Allegheny Reproductive Health Center (ARHC) regarding any questions. I also understand that I can ask ARHC staff for a copy of the printed materials published by the Pennsylvania Department of Health regarding pregnancy and pregnancy options.

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Current Time*

  • You will complete the following certification on the day of your abortion appointment. 

    Click the "submit" button at the bottom of this page to send your form to Allegheny Reproductive Health Center.

  • Certification of Compliance with 24-Hour Waiting Period

  • I hereby certify that the physician who I understand will perform my abortion or refer me to another physician who will perform the abortion, has orally informed me of the following:

    1. What an abortion is and how it will be performed, as well as the potential risks of both abortion and carrying the pregnancy to term (delivering).
    2. Alternatives to abortion, including carrying the pregnancy to term, setting up an adoption plan, or foster care.
    3. The probable gestational age of my pregnancy.
    4. Materials published by the Pennsylvania Department of Health, which offer information regarding abortion alternatives and fetal development, and that these materials are available to me at no cost if I request them.
    5. Medical Assistance benefits may be available for prenatal, childbirth, and neonatal care, and that more information regarding these benefits is in the state-printed materials.
    6. The person with whom I became pregnant is liable for child support, even if they have offered to pay for the abortion.

    By signing, I certify that all of my questions have been answered to my satisfaction, and that I have heard and understood the information required by the Pennsylvania Abortion Control Act at least 24 hours before my scheduled abortion. I also certify I was given the opportunity to request to see the state-printed materials, and if I requested these, that they were provided to me.

    Signature: _______________________   Date: ___________ Time: ___________

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