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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

Planned Parenthood has a fee schedule that's right for you.

All clinics accept Medicaid and some clinics participate in the Medicaid Women's Health Program.  Click here to enter your zip code to find the clinic closest to you. Please call the clinic for more information about financial assistance programs. 

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

Aetna**

Amerigroup Texas, Inc.

BlueCross BlueShield

Cigna

Community First

EBS Employee Benefit

Medicaid

Private Healthcare (PHCS)

Superior HealthPlan Inc.

Call us today to see if Planned Parenthood is in your health insurance plan's network. 

* Coverage and benefits subject to each health insurance plan's provisions. This list of health insurance plans is subject to change.

** Aetna - coverage for gynecological services and abortion care services at select clinics.

 

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.

 

 

 

 


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