Health Centers: Patient Services: Complete Your Paperwork
Once you've made your appointment, you can download forms here to save yourself time at the health center. By printing, filling out, and bringing your medical history and demographic information with you, you'll streamline your visit. Remember, medical privacy is very important to us at Planned Parenthood. We follow all HIPAA guidelines, and we will keep your visit confidential.
- If your appointment is for our abortion services, please download your paperwork from our Abortion services section.
- Download the Medical History Form (Historial Médico). Complete and honest information on this form will give your clinician a picture of your overall and sexual health, and let her know how best to help you.
- Men/Hombres – only for/solamente para Bedford, East Chicago, Elkhart, Gary, Michigan City, New Albany, Seymour and/y Scottsburg
- Download the Demographic Form (Hoja Demográfica). On this form, we need your name, address, phone numbers, etc., as well as your insurance or Medicaid information, if any.
All new patients must complete both the medical history and demographic forms. If you do not bring them with you, you will be asked to fill them out at the health center.
