Medical History Form - Planned Parenthood - plannedparenthood 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top, including your name, chart number, today's date, and date of birth.
3. In the 'Medical History' section, answer all questions accurately. Indicate any preferred names and gender pronouns.
4. Proceed to the 'Medication History' section. List any medications you take regularly and note if you've taken any today.
5. Complete the 'Allergies' section by specifying any allergies you have, including reactions.
6. Fill out the 'Surgical/Hospitalization History' and 'Family History' sections as applicable.
7. Continue through the form, addressing social history, vaccinations, tobacco and alcohol use, sexual history, STI history, HIV testing, relationship history, GYN history, PAP history, birth control history, and OB history.
8. Review all entries for accuracy before saving or submitting your completed form.

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