Appointment forms

Click on the links below for each form, and bring them with you to your visit. Please make sure to use a black or blue ink pen to fill out the forms.

Adobe Acrobat Reader is required to view the forms.

First-Time Patients

Please complete and sign one set of the following forms:

The information you provide on these forms is confidential. Answering the questions will help our medical center staff provide with most appropriate and comprehensive health care.


Planned Parenthood of Orange and San Bernadino Counties has been fighting for your reporductive health justice since 1965.

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