Forms

If you are new to the Women’s Community Clinic, you can save time by downloading, printing and filling out the following forms prior to your appointment.

New Client Paperwork (English)

New Client Paperwork (Spanish)

Consent to Bill and Treat: If you are the parent or guardian of a client under age 18 who is coming to the Clinic for primary care services, and you are unable to accompany them, please send a signed copy of this form with them. If you are an adult client, or are under 18 and coming to the Clinic for family planning services, you do not need to print this form.

Please bring these forms with you to your appointment. Please do not email these forms ahead of time.

Other Forms:

*NEW* Path to Making the Clinic Your Primary Care Provider Under Medi-Cal – Diagram.

Medical Records Request: To request that records be sent to or from the Women’s Community Clinic, please complete this form and fax it to us at 415.379.7804.

Emergency Contraception (Plan B) prescription form via San Francisco City Clinic: print out your own prescription and take it to your pharmacy