In requesting medical care through the San Francisco Free Clinic (SFFC), I hereby agree to the following: 

I understand that SFFC only provides care for patients without health insurance. I certify that I have no medical insurance or coverage under Healthy San Francisco (HSF), and that the problem for which I am being seen is not covered by Worker’s Compensation, insurance, or any other form of medical coverage (includes accident coverage, personal injury claims, or pending legal action). I will let SFFC know if and when my insurance status changes or any of the above listed apply, so that I may receive care elsewhere. 

I further understand that SFFC is a teaching facility, which provides educational opportunities for future medical practitioners. I understand that while my care will be overseen by an attending physician, I may be cared for by a medical student, resident physician, nurse practitioner, or physician assistant. Because the practitioners are often here on a temporary basis, I understand that it will not always be possible to be cared for by the same practitioner on an ongoing basis. 

I further understand that NO AFTER-HOURS CARE IS AVAILABLE. If an acute problem or emergency arises during hours when the clinic is not open, I will have to seek care elsewhere. After-hours information is provided on our website as a courtesy only (SFFC is not contracted with any of the listed hospitals or emergency rooms).