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This section consolidates the forms your clinic needs — including mifepristone prescriber agreements, patient consent forms, and ultrasound indication guidance — so nothing gets missed before dispensing.
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MAB Consent Form Pregnancy of Unknown Location (PUL)
A consent form for a medication abortion: pregnancy of unknown location (PUL) or pregnancy not seen on ultrasound.
Mife PRESCRIBER Agreement Form
A prescriber agreement form required to dispense 200 mg mifepristone tablets.
Mife PATIENT Agreement Form (Generic/ Standardized)
A standardized consent form required for patients prior to receiving mifepristone 200 mg.
Generic MAB Consent Form
A standardized medication abortion consent form used by Hope Clinic to document patient agreement prior to treatment.
Indications for Sonography for Medication Abortion
Absolute indications for using an ultrasound when providing a medication abortion.