Save time! Print and complete the following forms for your health center visit. Please use black ink.
If you are visiting a Texas health center, please use the forms below:
- Welcome to Planned Parenthood Information (PDF) form for your Family Planning clinic visit. Please use black ink.
- Authorization Form for Release of Health Information (Needed only if you need your records transferred to or from another location.) Imprima esta forma en español: Forma de Autorización para la Liberación de Información Médica.
Teens Access to Health Services: Some minors (under the age of 18) will be required to obtain consent from a parent or guardian before receiving certain medical services. Click here for more information.
Parental consent for medical services
Read the Health Information Privacy Practices. Lea el documento en español: Aviso sobre prácticas de privacidad relacionadas con información de salud.
Click here to see the Texas Notice of Required Reporting
If you are visiting a Louisiana health center, please use the forms below:
- Welcome to Planned Parenthood Information (PDF) form for your Family Planning clinic visit. Please use black ink.
- Authorization Form for Release of Health Information (Needed only if you need your records transferred to or from another location.) Imprima esta forma en español: Forma de Autorización para la Liberación de Información Médica.
Our health services are confidential. For more information you may read the Health Information Privacy Practices.(PDF)
Click here to see the Louisiana Notice of Required Reporting
