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It's easy. Complete the form online, print and bring it to the Planned Parenthood nearest you along with proof of residency. We'll help you do the rest. If you qualify, you can receive free family planning services the same day!

English: Application & Renewal Form

If you qualify, you can receive these Family Planning Services at PPSNE free of charge:

  • Birth control and emergency contraception
  • Comprehensive physical examinations
  • Testing and treatment for sexually transmitted infections
  • Pap tests
  • HIV testing and counseling
  • Education and counseling related to many of these services


  • Must have a valid social security number
  • Must have driver's license or passport
  • Income restrictions vary by region and family size

For More Info:
Contact Planned Parenthood of Southern New England
1.800.230.PLAN (7526)

English: Application & Renewal Form

Other coverage may be available for those who do not qualify for Family Planning Coverage Limited Benefit Program.

A HUSKY HEALTH Certified Entity (HHCE) may grant confidential presumptive eligibility to qualified individuals, based on the Department's criteria, who apply for Family Planning Services - Limited Benefit. Only the Department of Social Services may grant a provider HHCE status.


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