Life Dynamics


Patient’s Rights Form


Customers will receive a discount for orders 3 or more pads (75 or more forms).


This two sided form is a good tool in trying to get women to change their minds about abortion. It warns her not to let anyone perform an abortion on her unless they complete this document and provide: the abortionist’s name, malpractice insurance information, malpractice history, and licensure status.

The reality is, that not one single abortionist will sign this form, alerting the woman that she could be putting herself in danger.

Pregnancy resource centers and sidewalk counselors have used this form with amazing success. Their feedback is that this may be the most effective way to turn around the most determined and abortion-minded clients.

We guarantee you that babies and moms can be saved with this low-cost and effective tool! This form has been updated so that it is now easier to understand is much easier to write on.

(Also includes information about RU-486, the “abortion pill”.)

Note: Sold in pads of 25.


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  • This online shopping cart system can only be used for domestic United States orders. To have items shipped to Canada or other foreign countries, please call the Life Dynamics office at (940) 380-8800, between 8:00 AM and 5:00 PM, Central Time.
  • Sales tax of 8.25% will be automatically added to purchases made in Texas.
  • Sample products and free items cannot be shipped to a third party. For these items the person placing the order must be the recipient.
  • There is no tax or shipping & handling charged on free items.
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