San Francisco Health Service System (SFHSS) members should use this form to notify SFHSS of a change in their mailing address. Your request will be processed by a Member Services Benefits Analyst. SFHSS respects your privacy. Your contact information is used only by SFHSS - this information is never shared.

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1. Which type of SFHSS Member is requesting an address change?

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2. What is the SFHSS Member's NEW HOME ADDRESS?
Street addresses only. Enter P.O. Box addresses under Mailing Address below.
If you have any questions about changing your Home Address, please call
SFHSS at (415) 554-1750.

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3. What is the SFHSS Member's NEW MAILING ADDRESS, if any?
Mailing addresses are optional. Do not enter anything if your mailing address is the same as your Home Address.

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4. What is the SFHSS Member's Preferred Phone Number?
SFHSS may require phone confirmation of this change of address request.

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5. What is the SFHSS Member's Preferred email Address?
SFHSS may require confirmation of this change of address request by email.

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