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 | Vietnamese
Need a Ride?
If you have Medi-Cal insurance, you can get free transportation to your Medi-Cal covered appointment.
View form for more information.
Please note that this is being offered by the health plans so Planned Parenthood is unable to arrange the transportation or answer questions about the service.