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Advisory Committee Quarterly Report

MO 1

MO 2

MO 3

TOTAL

Calls to Hotline

Total:

In-depth Abortion counseling

Total:

New Adult Clients (In Office for First time)

Total:

Counseling Sessions

Total:

Post-Abortive Counseling

Total:

Adoption Referrals/Placements

Total:

Pregnancy Tests

Total:

Positive Tests

Total:

Negative Tests

Total:

Totals

Total:

Total:

Total:

Total:

Address to Mail Check:

if available
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