Take This Form to your Doctor

If you have a doctor:

1. Download the form on the right

    

2. Fill it out

    

3. Take it with you to your next
   doctor's appointment

We encourage you to get tested at your own doctor's office so that your doctor can monitor your health. 

• English version

• Chinese (traditional)

• Chinese (simplified)

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• Hmong

• Korean

• Laotian

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• Samoan

• Tagalog

• Vietnamese

San Francisco residents that don't have a doctor are encouraged to visit our low-cost and/or free partner clinics in San Francisco. 

Click here for locations and hours.