Medical Forms
All patients must bring valid, state-issued photo identification with them for each health center visit.
Additionally, appointments are suggested for all locations and many do not accept walk-up patients. Please call 1-800-230-PLAN to make an appointment.
First visit? Download forms here to save yourself time at the health center.
Thank you for choosing Planned Parenthood Southeast! Upon your first visit to our health centers, you will need to fill out a number of forms to help us to know how best to serve you.
Click the titles below to access the forms as PDF documents, which may require Adobe Acrobat Reader to open and print. The information you provide on these forms is strictly confidential in accordance with our Privacy Policy (view in English or Spanish).
All new patients must submit 3 forms.
- Registration Form
- Plus, a medical history. Choose one:
The information you provide on these forms is strictly confidential in accordance with our Privacy Policy (view in English or Spanish). If you have any questions or concerns, please call 404.688.9300.
Need to request your Medical Records? Follow these steps:
1. Select the form that matches the state that you were seen in:
2. Print the form, fill it out. Be sure you indicate where you want your records sent and sign it!
3. Fax it to the health center you were seen at. The health center information and fax numbers are listed on the forms linked above.
Non-Discrimination Notice
Planned Parenthood Southeast, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Planned Parenthood Southeast, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Click to see our full non-discrimination policy in English or Spanish.
Click to read our Notice of Health Information Privacy Practices