With each visit, you will be asked to fill out some forms. The information on these forms helps us to evaluate your medical history and any health concerns. You can download PDF forms here and fill them out in advance of your visit. This will make your visit go faster.
Please make sure all forms are filled out in black ink as we cannot accept forms filled out in other colors or in pencil. Please do not sign these forms until you come to the health center.
Click to download PDF forms:
- Birth Control Start without Pelvic Exam (H.O.P.E)
- Initial (First) Well-Woman Exam with Planned Parenthood
- Pill/Patch/Ring/Depo Check-Up
- Pregnancy Test
- Limited Services/Problem Visit/STI Check - MALE
- Limited Services/Problem Vist/STI Check - FEMALE
- Abortion with the Abortion Pill
- In-Clinic Abortion
NEW patients (for non-abortion services) must also complete the following two forms:
