Planned Parenthood of South Central Michigan has served the communities of Southwest Michigan with confidential, high-quality, affordable sexual health care for over 40 years.
We schedule appointments at all our health centers, so you don't have a long wait to be seen for a check-up. You are welcome to walk in anytime during business hours to pick up supplies. You can count on us for high-quality personal care at an affordable price in Kalamazoo, Battle Creek, Coldwater, and Three Rivers.
SAVE TIME! FILL OUT THE FORMS YOU NEED
BEFORE YOUR APPOINTMENT!
How To Complete Your Paperwork (All files are PDF):
- Read, sign and date request for medical services consent.
- Complete patient data form. Sign and date at bottom of page.
- Complete both sides of medical history. Sign and date at the bottom of back page.
- Complete highlighted areas on both sides of authorization form for release of health information. Sign and date on both sides.
- (Optional) read notice of health information privacy practices handout.
Como Completar Tu Papelo:
- Lee, firma y ponle la fecha a la forma que solitica consentimiento para servicios medicos.
- Completa la forma para pacientes. Firma y ponle la fecha al final de la página.
- Completa los dos lados del historial medico. Firma y ponle la fecha al final de la página.
- Completa las areas subrayadas en los dos lados de la forma de autorizacion para entregar datos medicos. Firma y ponle la fecha en los dos lados.
- (Opcional) lee el aviso de informacion de la privacidad de practicas de salud.
