What kinds of questions are on the paperwork we need to fill out?

What a great question!  At Teen Clinic, we require everyone to fill out three forms:

  • Our privacy policy. By law, all health professionals must protect the confidentiality of their patients. They must also inform patients of their privacy rights. By signing this form, Teen Clinic patients are acknowledging that they have read the policy and know their information is confidential.
  • Our Family Planning consent.  This consent form tells patients more about our services.  We do not ask patients any questions on this form, but we do require that everyone signs it.  Among other things, the form lets patients know we are required by law to report certain medical information; by signing, a patient is consenting to our services.
  • Our demographic form. Funding for Teen Clinic comes from a lot of places.  One of these is Title X, a federal family planning program that subsidizes birth control costs for low-income people. In order to receive this funding, we are required to collect information on the income and insurance status of our patients.   Teen Clinic also receives funding from private foundations and local governments, as well as private individuals. Sometimes our funders want to know what types of people we are reaching. Because of this, our demographic form includes questions about your address, disability status, race, ethnicity, language, gender/sex, and sexual orientation. Lastly, it’s important that we know certain important things about our patients! Your name, birthdate, relationship status, emergency contact and whether or not your parents know you are here are all important to your care. We also want to know whether it’s okay to text you, call you, leave you a message, or send mail.

Depending on what you’re here for, you may need to fill out forms about your medical health history. On these forms, we ask questions about your family’s health history, your menstruation (if female), your nutritional and exercise habits, and your drug and alcohol use. You may also be asked to answer questions about the number of partners you’ve had, sexual activities you’re engaging in, and condom use. Please answer these questions honestly!  Having your most up-to-date, accurate information will allow us to fully address your health concerns.

If you have any specific concerns about Teen Clinic paperwork, feel free to ask! Give us a call at the clinic to talk to someone about paperwork. You can also talk to the Front Desk employee when you are filling out your forms.