Insurance and Forms
Insurance Information
What insurance do we accept?
• Cal-Optima
• Family PACT (can be qualified on-site)
• Medi-Cal
• Some private insurance (please call ahead for eligibility verification)
Payment Information
Fees are based on a sliding scale determined by the patient’s monthly income and number of dependents. We accept cash, all major credit cards, and in-state personal checks
Medical Forms
Family PACT
To cover your services if you are without insurance.
Download Family PACT form - English | Spanish
Medical Release Form
To request your medical records be sent to Planned Parenthood or mailed to you by Planned Parenthood please fill out a HIPAA release form.
Download medical release form - English | Spanish