Patient Forms
You may download these forms and complete them prior to your appointment:
AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION
AUTORIZACIÓN PARA EL COMPARTIR INFORMACIÓN MEDICA
SOLICITUD DE RESURTIDO ANTICONCEPTIVOS
MEDICATION ABORTION INFORMATION FORM
MEDICATION ABORTION INFORMATION FORM (SPANISH)
SURGICAL ABORTION INFORMATION FORM
SURGICAL ABORTION INFORMATION FORM (SPANISH)
HIPAA Privacy
You may download these forms and review for privacy information:
NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES
This notice describes how health information about you may be used or disclosed by Planned Parenthood of Greater Ohio and how to access this information.
AVISO SOBRE PRÁCTICAS DE PRIVACIDAD RELACIONADAS CON INFORMACIÓN DE SALUD
Este aviso describe cómo la información relacionada con su salud puede ser usada o divulgada por las oficinas de Planned Parenthood of Greater Ohio y cómo puede usted tener acceso a dicha información por favor, lea este aviso detenidamente.
PATIENT HEALTH RECORDS REQUEST
For more information about requesting your patient health records, click here
No Surprises Act
Your rights and protections against surprise medical billing: click here