Imagine
Pro-Choice Abortion Resolution Work
Charlotte Taft & Shelley Oram
PO Box 428, Glorieta, NM 87535
Reach our voice mail at any time 505-757-2991

E-Mail us for more information at CharloTaft@aol.com


Patient Self Test



Please answer all these questions in whatever way is most true for you.

Are you willing to talk about your feelings about abortion in counseling today?

How are you feeling today? (Circle all that apply)
Confident
Angry
Happy
Trapped
Relieved
Afraid
Mean
Strong
Worried
Curious
Relaxed
Sad
Guilty
Peacevul
Ashamed
Numb
Resolved

Which is NOT TRUE, SOMEWHAT TRUE, or TRUE for you about the abortion during this past week?

1. I thought about it when I didn't want to or mean to

2. I tried not to talk about it or have feelings about it.

3. I had trouble sleeping because of thinking about it.

4. I've felt like it wasn't real, or it wasn't really happening to me.

5. I was aware I had alot of feelings, didn't want to deal with them.

6. Sometimes I think about hurting myself.

Which is:
1) Not true for me
2) somewhat true for me
3) True for me

1. I believe abortion is the same as murdering a born person.

2. I am not sure if I am making the right decision.

3. I don't want an abortion, but I have to have one.

4. I know I will regret having an abortion.

5. My parents are rejecting, critical and abusive.

6. The man involved is abusive, rejecting, and controlling.

7. I think God will punish me for having an abortion.

8. I will not be able to forgive myself for having an abortion.

9. No one else is giving me emotional support right now.

10. someone else if forcing me or pushing me into an abortion.

11. I am never going to think about it again after it's over.

12. I suffer from depression or diagnosed personality disorder.

If you are religious, what religion are you?
If you have a religion, do you think your religion is against abortion?
How important are religious / spiritual views to you?

Please put a check mark next to any concerns you are having:

___I don't understand how an abortion is done.

___I'm scared than an abortion is dangerous.

___I'm scared it will hurt.

___I'm wondering what the pregnancy looks like--how developed it is.

___I'm worried that I won't be able to have children later if I want to.

___I'm worried about how to avoid getting pregnant in the future.

___I'm worried about my relationship with the man involved / or withmy family.

___I'm worried about my job or money problems.

___Other worries?

What is your definition of abortion?




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