Save time!
Print visit forms, fill them out and bring them to your PPGG visit. Locate the forms you need from the list below, click on the links for the forms you need, print them out, and bring the completed forms with you to your visit.
Adobe Acrobat Reader is required to view the forms. You can download Acrobat reader for FREE by clicking here.
If you have never been to a Planned Parenthood Golden Gate health center or if it has been more than two years since your last visit, please bring these forms:
Female, new paitent or Male, new patient
First-time patients, please also read our Health Information and Privacy Policy before your visit. Click here to download and print the form.
| Forms Needed to Request Your Medical Records |
If you want your records released to a third party, fill out this authorization to release your health information.
If you want your records released to yourself, fill out the request for access form.
The information you provide on these forms is private and confidential. Answering the listed questions will help our medical staff provide you with the most appropriate and comprehensive health care. Thank you for your cooperation.
Health Center Fax Numbers:
|
Hayward:
Oakland (Eastmont):
Oakland (MacArthur):
Redwood City:
Rohnert Park:
San Francisco:
San Mateo:
San Rafael:
|
510-537-6024
510-562-9409
510-547-7446
650-369-7282
707-584-3924
415-885-2462
650-574-3894
415-454-0873
|
|
If you have a medical emergency, please call 9-1-1 or go to the nearest emergency room.
For same-day or urgent appointments, please call:
1-800-967-PLAN (1-800-967-7526)
|
|
