Protocol and Referral Templates

Sample Letter to GP

An example of a letter that can be provided to local GPs to inform them that you offer a medical abortion service. (Source: Gateway Health)

Sample Letter to Emergency Department – Rh positive patient

An example of a letter that can be given to an Rh positive patient in case they need to visit an emergency department due to complications from a medical abortion. (Source: Gateway Health)

Sample Letter to Emergency Department – Rh negative patient

An example of a letter that can be given to a Rh negative patient in case they need to visit an emergency department due to complications from a medical abortion. (Source: Gateway Health)

Sample Letter to Pharmacy

An example of a letter that can be given to a patient to take to the pharmacy dispensing the medication for medical abortion. Includes a witness statement that the pharmacist must return to the prescriber. (Source: Gateway Health)

Sample Patient Information Sheet

An example fact sheet that can be given to the patient that explains the medical abortion process. (Source: Gateway Health)

Sample Consent Form

An example of a patient consent form for prescribing medical abortion medication. (Source: Gateway Health)

Information for people who have had a medical abortion

An information sheet for patients who have had a medical abortion to help them understand what to expect after the procedure. (Source: Royal Women’s Hospital)

Medical Abortion Information for Administration Team

A helpful information sheet for the medical abortion process designed specifically for the administration staff. It includes detailed information about time frames of appointments and medical tests. (Source: Gateway Health)