Patient Forms
Save time before your appointment by submitting outside records or completing the release forms you need before your visit. Forms and records can be submitted to our Medical Records department using this link.
Iowa and Nebraska Health Centers
Medical Records Release Forms
Need a copy of your medical records? You will need to complete a Release of Information. Please read the descriptions below and fill out the form that apples to you, then fax the completed form to 651-696-5543 or submit it through this link.
- Medical Records Release TO/FROM Planned Parenthood-IA, NE (PDF)
Use this form if you want to send Planned Parenthood Iowa, Nebraska a copy of your records from another provider or if you want to send a copy of your Planned Parenthood Iowa, Nebraska medical records to another provider or third party. Note: You don't need this form to switch between Iowa and Nebraska health centers - Medical Records Release to Self-IA, NE (PDF)
Use this form to request a personal copy of your medical records. - Divulgación de información a uno mismo- IA,NE (PDF)
Usa este formulario para solicitar una copia personal de tu expediente médico. - Divulgación de información hacia o desde- IA,NE (PDF)
Utilice este formulario si desea enviar a Planned Parenthood Iowa, Nebraska una copia de sus registros de otro proveedor o si desea enviar una copia de sus registros médicos de Planned Parenthood Iowa, Nebraska a otro proveedor o tercero. Nota: No necesita este formulario para cambiar entre los centros de salud de Iowa y Nebraska.
Minnesota and South Dakota Health Centers
- No-Cost Birth Control Application (PDF)
No insurance? You may qualify for no-cost birth control at one of our Minnesota health centers. Fill out this form and bring it to your visit to apply.
Note: New immigration rules may apply to this program.
Medical Records Release Forms
Need a copy of your medical records? You will need to complete a Release of Information. Please read the descriptions below and fill out the form that apples to you, then fax the completed form to 651-696-5543 or submit it through this link.
- Medical Records Release TO/FROM Planned Parenthood-MN, ND, SD (PDF)
Use this form if you want to send Planned Parenthood Minnesota, North Dakota, South Dakota a copy of your records from another provider or if you want to send a copy of your Planned Parenthood Minnesota, North Dakota, South Dakota medical records to another provider or third party. Note: You don't need this form to switch between Minnesota, North Dakota, and South Dakota health centers. - Medical Records Release to Self- MN, ND, SD (PDF)
Use this form to request a personal copy of your medical records. - Divulgación de información a uno mismo-MN, ND, SD (PDF)
Usa este formulario para solicitar una copia personal de tu expediente médico. - Divulgación de información hacia o desde-MN, ND, SD (PDF)
Utilice este formulario si desea enviar a Minnesota, North Dakota, South Dakota una copia de sus registros de otro proveedor o si desea enviar una copia de sus registros médicos de Planned Parenthood Iowa, Nebraska a otro proveedor o tercero. Nota: No necesita este formulario para cambiar entre los centros de salud de Minnesota, North Dakota, y South Dakota.
Questions about which form to fill out? Give us a call at 1-800-230-7526.