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Treatment and No Show Rules
*
Indicates required field
Date
*
Patient Name
*
I understand that if I do not follow the Doctor’s recommended treatment at the Genesee County Free Medical Clinic or fail to show for three (3) appointments, my ability to use the Genesee County Free Medical Clinic as a medical home will be terminated.
Patient's Signature
*
Submit
Home
About
Patient Form Portal
Rules Form
Checkin Form
Consent Form
Treatment and No Show Rules
Eligibility Application
How you can support
Executive Board
Volunteer App
WISH LIST
Happenings
