Patient Forms and Information

Planned Parenthood of Greater New York cares about the quality of information and service that you receive at our health centers. See below for patient forms and information.

Request for Medical Records

To transfer your records from PPGNY to another health facility, please fill out this form and mail or bring it to PPGNY.

Patient Bill of Rights

Read PPGNY's Patient Bill of Rights in English and Spanish to find out about your legal rights as patients.

Statement of Commitment to Equitable Care

Planned Parenthood of Greater New York actively works toward being a multicultural, inclusive, and anti-racist organization where staff, patients, and community of all identities can thrive.

HIPAA Privacy Policy

Read PPGNY's HIPAA Privacy Policy to learn about our privacy practices concerning health information about our patients.

Financial Assessment and Patient Contact Form

If you are a new patient of the Corning, Elmira, Hornell, Ithaca, or Watkins Glen health centers, please download the patient intake form at the link below, complete in advance, and bring to your visit.

Family Planning Benefit Program Application Instructions

Family Planning Benefit Program Application

Instructions for Patients Having Procedures

Surgical Abortion with Moderate or Deep Sedation (in Manhattan)

Surgical Abortion with Local Sedation (in Manhattan)

Surgical Abortion with Minimal Sedation (in Manhattan, Brooklyn, Bronx, or Queens)

Surgical Abortion with Local Sedation (in Brooklyn, Bronx, or Queens)

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