PATIENT FORMS

We highly recommend you get tested for hepatitis B. Use this form on the right to show to your doctor to get tested.

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. 

  • Chinese (traditional)

  • Chinese (simplified)​

  • Hmong

  • Korean

  • Laotian​

  • Samoan

  • Tagalog

  • Vietnamese

DON'T HAVE A DOCTOR?

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.
Patient Form