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When you are ready to schedule your appointment, we encourage you to print and complete the following forms. You will need Adobe Acrobat to download these forms.

These forms are available at the health care center, as well.

 Patient Care:

We are proud to offer inclusive, compassionate care to all patients anywhere on the gender spectrum. Planned Parenthood understands that each individual's gender identity is personal and unique. 

Patient Forms:

Health History Form

Request for Medical Services Form*


* Indicates we are required to collect this form before providing any medical service.

 

Abortion Patient Forms:

Medication Abortion Medical History Form (PDF)

Surgical Abortion Medical History Form (PDF)

 

Records Request/Release Information

If you need your records transferred to or from PPMT you can use this form. Please be sure to specify if you are requesting a records transfer to another provider or if you are requesting that your records are transferred to PPMT.

Authorization Form to Request/Release Medical Records (PDF)