close

Patients Forms

Preparing for Your Visit

  • All patients, including minors, are required to bring with them a valid form of photo identification.

A number of forms are required to be completed at your first appointment and subsequent appointments. For your convenience you may download and complete the forms prior to your appointment.

Please select the correct forms for your appointment, download, print, and fill out the forms in black or blue ink (if forms are filled out in pencil or another colored ink you will be asked to fill out the forms again). Do not sign the forms until you come to the health center for your appointment. Bring all completed forms with you to your appointment.

If you need assistance making sure you download the correct forms, please call the health center where your appointment is scheduled.

Prior to completing the forms above please review our HIPAA Privacy and confidentiality policy.

  • HOPE - Birth control consultation only.
  • FEMALE EXAM -  Appointments for Well Woman Exam, Pelvic Exam, STI testing and treatment, UTI testing, Yeast infection check, Partner treatment, Genital Wart treatment, etc.
  • MALE EXAM - Appointments for STI testing and treatment, Partner treatment, Genital Wart treatment, Consultations, etc.
  • Need to transfer or obtain medical records?

    If you are faxing or mailing a records requests form please include a copy of your Photo ID.

    To obtain your medical records you will need to fill out a Medical Request Form. Once the form is complete either fax, mail,or bring the form into the health center. MEDICAL RECORDS REQUEST

    If you are wanting to transfer your birth control prescription and medical records to another Planned Parenthood please complete the TRANSIENT FORM and fax, mail, or bring the form to your current health center.


    Find A Health Center

    or

    Or Call
    1-800-230-PLAN