Medical Forms

When you first visit the health center, our staff may ask you to fill out a number of forms. These materials will help us to know how best to serve you and will give you a chance to let us know your health concerns.  You can download forms here to save yourself time at the health center.

These forms are PDF documents, which require Adobe Acrobat Reader to open and print.

Printing, completing, and bringing forms with you should help shorten your visit.

The information you provide on all of these forms and your visit is strictly confidential (see the PPSE Notice of Privacy Practices in English and the PPSE Notice of Privacy Practices in Espanol/Spanish).  

Registration Form (pdf)

Medical History Form (Women) (pdf)

Medical History Form (Men) (pdf)

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