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Planned Parenthood

Columbia Willamette

Patient Forms

Coming to Planned Parenthood for an appointment? Download the forms you'll need now and fill them out before your visit. Please complete all forms with blue or black ink.

  1. Patient Registration Form
    Complete this form if you are a new patient OR if your contact information has changed since your last visit to Planned Parenthood.
  2. Health History Form
    Complete this form if you are a new patient OR if it has been more one year or more since your last visit to Planned Parenthood.
  3. Funding Application Forms
    If you are applying for a state funding program, please complete the application form for the state where you live.

Other Forms:

  • Information Release Form: If you'd like to request that we send your medical records to another medical provider, or have another medical provider send us your records,please fill out this form and fax, mail, or hand-deliver it to your Planned Parenthood health center.
  • Consent for Prescription Pick Up: If someone else is picking up an existing prescription for you at one of our health centers, please print and complete this form. Whoever picks up a prescription for you must have this completed form and a photo ID, along with payment for any applicable charges.

To schedule an appointment, call 503.788.7273 or 1-888-576-PLAN (7526).

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Patient Forms