Planned Parenthood

Western Pennsylvania

Medical Forms

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.

Click on the appropriate forms below to download:

Family Planning Intake Form

Family Planning History Form

Abortion Services Intake Form

Abortion Services History Form




If you are currently or have previously been a patient at any PPWP health center and would like a copy of your records for yourself or your current health care provider, you can download those forms here:

Release of Records to Self

Release of Records to a Third Party


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Medical Forms