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Planned Parenthood

Arizona

Online Patient Forms

En Español »

 

If you want to prepare for your appointment, you can fill out the Patient Information Form and bring it with you to your scheduled appointment.

 

If you'd like to release your medical records to another medical provider for continuing care, or if you'd like to obtain a copy for yourself; print and complete this form. Once completed, you may take it to the Planned Parenthood Arizona health center where you have received services, or you can mail it to our administrative office:

 

Attn: Medical Records
4751 N 15th St
Phoenix, AZ 85014

 


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 by using this link.

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Online Patient Forms