Planned Parenthood

Greater Washington and North Idaho

Printable Forms

If you are a self-paying client or applying for funding, please make sure to bring proof of income and photo ID with you. If you are paying with insurance, please make sure to bring your insurance card, co-pay,and a photo ID.

Please print clearly in blue or black ink.

Take Charge Application: English  Espanol 

Release of Information


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Printable Forms