Planned Parenthood


Patient forms & payment information

PPOLwebCareNoMatterWhat10-23-15.pngWe have been serving women, men and young people for over 89 years in Pennsylvania. You can trust us to provide high quality essential health care.
We accept most insurance plans and will help you learn about ways to afford our health care services. 

Payment is expected at the time of each visit. We accept cash, checks, Visa, MasterCard, and Discover cards. Please bring a photo ID card and, if you have them, your insurance cards with you to each visit.

With each visit, you will be asked to fill out some forms. The information on these forms helps us to evaluate your medical history and any health concerns. 
Female Medical History
Female Medical History (Span)
Male Medical History
Male Medical History (Span)
Patient Contact Information 
Patient Contact Information (Span) 

If you are currently or have previously been a patient at any PPKey medical center and would like a copy of your records for yourself or your current health care provider, you can complete this Medical Records release form and bring it to your medical center. 


  • tumblr icon
  • google plus icon
  • twitter icon
Patient Forms & Payment Information