Medical Forms
5 Minutes Saves You $5!
Would you like to save money on the cost of your Planned Parenthood appointment? Take 5 minutes before your health center visit, print and fill out the necessary paperwork, then give it to our health center staff and you'll get $5 off of your bill - easy as that!
You're eligible for this offer if you:
- are a new patient
- have an abortion services appointment scheduled, or
- haven't visited your local Planned Parenthood health center since October 2010.
Please DO NOT SIGN THE FORM until you are in the health center and our staff can witness your signature.
Paperwork
Female History Form (English)
Female History Form (Spanish)
Male Visit Form (English, shaded areas only)
Consent for Medical Services (English)
Consent for Medical Services (Spanish)
Contact Form (English)
Contact Form (Spanish)
Abortion Services Paperwork
If you plan to partake in abortion services at a Planned Parenthood healthcare clinic, please refer to the abortion paperwork necessary to move forward:
Medical History Form for an Abortion Appointment (English)
Medical History Form for an Abortion Appointment (Spanish)
Consent for Medical Services for Minors Seeking Abortion (English) Consent for Medical Services for Minors Seeking Abortion (Spanish)
Contact Form (English)
Contact Form (Spanish)
Abortion Access for Minors - Parental Notification Forms
Transferring or Obtaining Your Medical Records
Planned Parenthood of Southwest and Central Florida requires you to sign a release if you plan to transfer or obtain your medical records. Please allow up to 10 business days to process each paperwork request and keep in mind that fees may apply. To find out more about abortion paperwork, or if you have any additional questions, please contact your local health center.
To send your medical records to another healthcare provider, upload the PDF version HERE.
To have a copy of your medical record sent directly to Planned Parenthood, upload the PDF version HERE.
Protesters
A woman’s health and safety are our priority. If you plan to visit a Planned Parenthood healthcare clinic, click HERE to find out some information and tips about protesters.
