Print visit forms, fill them out and bring them to your PPGG visit. Locate the forms you need from the list below, click on the links for the forms you need, print them out, and bring the completed forms with you to your visit.

Adobe Acrobat Reader is required to view the forms. You can download Acrobat reader for FREE by clicking here.

Ahorrese tiempe y llene sus formularios en casa y traigalos a su cita. Clic aquí.

Save waiting time by filling out your paperwork at home and bringing it in with you to your appointment.

Female: 

• Registration and FPACT eligibility 
• Medical History

Male:

• Registration and FPACT eligibility 
• Medical History

First-time patients, please also read our Health Information and Privacy Policy before your visit.

• For to a third party (like another doctor's office), fill out the Authorization for Release of Medical Records form to release your health information.
  
• For yourself, fill out the Request for Access to Health Information form.

The information you provide on these forms is private and confidential. Answering the listed questions will help our medical staff provide you with the most appropriate and comprehensive health care. Thank you for your cooperation.

If you have a medical emergency, please call 9-1-1 or go to the nearest emergency room.

For same-day or urgent appointments, please call:
1-800-967-PLAN (1-800-967-7526)