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Patient Information Forms

  • Please download the patient information form and complete it prior to your visit. Please bring a photo ID, insurance card, and completed patient form. 

    Patient Information Form (English) (Spanish)

Record Request Forms

  • If you would like to transfer or obtain a copy of your medical records, fill out the records request form. Please allow up to 10 business days to process each request. 
    Send the request form to [email protected] or
    fax to 602-296-0154.

    Records Request Form (English) (Spanish)

Patient Forms

Forms are in PDF format and require Adobe Acrobat Reader to open and print. This is a free program and is easy to install.  If you do not have Acrobat Reader, please install now to view our patient forms.


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Planned Parenthood cares about your data privacy. We and our third-party vendors, use cookies, pixels, and other tracking technologies to collect, store, monitor, and process certain information about you when you access and use our services, read our emails, or otherwise engage with us. The information collected might relate to you, your preferences, or your device. We use that information to make the site work, analyze performance and traffic on our website, to provide a more personalized web experience, and assist in our marketing efforts. We also share information with our social media, advertising, and analytics partners. You can change your default settings according to your preference. You cannot opt-out of required cookies when utilizing our site; this includes necessary cookies that help our site to function (such as remembering your cookie preference settings). For more information, please see our Privacy Notice.



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We use qualitative data, including session replay, to learn about your user experience and improve our products and services.



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