Patient Forms & General Information

Patient Forms

For your convenience, you can fill out patient forms prior to your appointment. Simply print out and complete the Patient Intake Form (en Español) and the appropriate Medical History Form for your gender: Female (en Español) or Male (en Español). Please fill out the forms in BLACK ink only and bring with you to your appointment.

Payment Options

We have a fee schedule that's right for you.

All clinics accept Medicaid and our Planned Parenthood clinics also operate a sliding fee scale based on family size and income.  Contact us for more information about financial assistance programs. 

We accept many health insurance plans, including the following*:

BlueCross BlueShield

Community First


Superior HealthPlan Inc.

Call us today to see if we're in your health insurance plan's network. 

* Coverage and benefits subject to each health insurance plan's provisions

Please read our Health Information Privacy Policy hereEn Español


Minors and Access to Health Care

Special note regarding minors and access to health care: Some minors (under the age of 18) will be required to obtain consent from a parent or guardian before receiving certain medical services. Questions about minors and access to services can be directed to clinic staff.

Find A Health Center


Or Call