GIHW 2024 San Mateo Patient Registration
Thank you for expressing interest in receiving medical services with the Global Initiative for Health and Wellness.

Services are located at the following locations. Please verify what location you are signing up for when selecting a date below:
You will receive an email with a copy of your responses to this form. This email should also contain a link where you can edit your response, if you need to reschedule or cancel your appointment. By providing us with an accurate count of patients who will be visiting us each day, you ensure that we are able to provide the needed services in a timely manner.

For more information, please visit www.gihw.org/clinics/san-mateo

No ID nor proof of insurance is required, this program is completely free and open to the public.
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Email *
First Name *
Last Name *
Date of Birth *
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Appointment Date *
Are you requesting to be vaccinated at your appointment? *
Required
A copy of your responses will be emailed to the address you provided.
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