San Francisco Health Plan: Members: Report a Problem

Health Text Messaging Program Registration Form

Choose your program :
Member FirstName :	Required Please enter only text.
Member LastName :	Required Please enter only text.
Guardian / Parent Name (if applicable) :
Cell Phone # to receive Text :	Required Please enter valid phone number.
Member ID:	Required Please enter valid Member ID.
Optional - Mailing Address :
Optional – Email :
Do you have a question for our health educator?

	By submitting this form, you agree to the following: •You may cancel this program at any time by texting STOP •Text messages do not provide diagnosis or treatment and are intended for general information purposes. •The text messages are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your primary care provider with any questions you may have regarding medication, medical conditions, or treatment. • This is a free service but your text messaging service plan does apply and you will be charged from your service provider if you go over your monthly text message limit.