Complete Your Patient Forms in Advance for a Quick Visit
With each visit, you will be asked to fill out some forms to help us evaluate your medical history and any health concerns. You can download the necessary PDF forms below and fill them out before your visit to ensure a timely visit.
Please make sure all forms are filled out in black ink, as we cannot accept forms completed in other colors or in pencil.
Please do not sign these forms until you come to the health center.
Click to download PDF forms:
- Birth Control without Pelvic Exam (HOPE)
- First Well Woman Exam with Planned Parenthood
- Birth Control Method Check-up (LARC/Pill/Patch/Ring/Depo)
- Pregnancy Test
- Limited Services/Problem Visit
- STI Check
- Patient Authorization for Release of Medical Information
- FORMULARIO DE AUTORIZACION PARA COMPARTIR U OBTENER INFORMACION MÉDICA
No Insurance? No Problem.
If you are a Maryland resident and a U.S. citizen or qualified legal resident, you may be eligible for one of Maryland's medical assistance programs. To find out more about medical assistance programs, click here.