Abortion Receipt generator

Confidential is where the patient's name goes on this abortion receipt, and most reproductive health clinics do it that way. Clinical consultation and ultrasound at $145.00, medication abortion care at $425.00, post care counseling and support at $55.00. That adds up to $625.00. The provider line says Licensed Medical Staff instead of a doctor's name, because the billing at this clinic does not attach a specific physician to the visit. Riverbend Women’s Health Center at 2241 Eastlake Ave E, Seattle, WA 98102 is the clinic on this one. Phone (206) 555-8412. The bottom of the receipt says please retain this for your private medical records, which is a line you would find on just about any clinic receipt in King County. The patient's name is editable. You can make an abortion receipt for a different visit by typing a real name or leaving it as Confidential. Three services on this one. The service descriptions and the prices are editable. The clinic name and the address are not locked in either.