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Your Rights

  • To be treated with dignity and respect.
  • To have complete privacy for your conversations and records. We will not release information to anyone without your permission.
  • To understand why we request certain personal information, including demographic info and medical history, and what we do with this information.
  • To understand why certain procedures and tests are required.
  • To refuse any treatment that you do not understand or do not want.
  • To be free from neglect, exploitation, and verbal, mental, physical, or sexual abuse.
  • To seek help from our staff if you feel unsafe.
  • To get complete information and education about birth control and pregnancy options.
  • To discuss with your clinician any questions or problems with your medical care.
  • To ask questions and receive explanations.

 

Your Responsibilities

  • To be sure you understand the information and instructions you are given, and ask questions if you are unclear.
  • To respect our policies and staff.
  • To arrive at your appointments on time.
  • To answer our questions honestly.
  • To be serious about following instructions for using medicine and birth control.
  • To tell us promptly if anything changes about your health.

 

Estimating the Costs of your Visit 

Let us know if you'd like a free estimate of the costs of your care. This estimate is good for 30 days and is our best guess of what you'll be charged. The estimate is not binding, and is not a guarantee of the final billed charges to you. Your final bill may be different from the estimate we give you for reasons such as complications, recommended treatment, and services ordered by your provider. If you ask for an estimate, we will give it to you within five business days.

 

PPINK Statement on Non-Discrimination

It is the policy of Planned Parenthood of Indiana and Kentucky to provide access to high-quality health care without discrimination against, or harassment of, any person on the basis of age, race, color, religion, sex/gender, gender identity or expression, sexual orientation, disability, pregnancy/number of pregnancies, contraceptive preference, genetic characteristics, ancestry, national origin, citizenship, residency, marital status, veteran status, or any other legally protected characteristic. Further, no patient will be denied service because of inability to pay.

 

Paperwork and Privacy

Once you've made your appointment, you can download forms here to save yourself time at the health center. By printing, filling out, and bringing your demographic information with you, you'll streamline your visit. Remember, medical privacy is very important to us at Planned Parenthood. We follow all HIPAA guidelines, and we will keep your visit confidential.

  • Download the Notice of Health Information Privacy Practices for your review prior to your visit. This form is for review only, no signature required.
  • Download the Demographic Form (Hoja Demográfica). On this form, we need your name, address, phone numbers, etc., as well as your insurance or Medicaid information, if any.
    • English (PDF)
    • English (PDF) – only for Elkhart, Gary, Michigan City, New Albany, and Seymour.
    • Español (PDF)
    • Español (PDF) – solamente para Elkhart, Gary, Michigan City, New Albany, y Seymour.

All new patients must complete the demographic form. If you do not bring it with you, you will be asked to fill it out at the health center.