Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. The purpose of this study is to examine health-related quality of life (HRQoL) among free clinic patients and its association with somatic symptoms, depression, and perceived neighborhood environment. Free clinic patients (n = 186) aged 18 years or older completed a self-administered survey. HRQoL, depression, somatic symptoms, and perceived neighborhood environment were measured using standardized instruments. Overall, the participants reported low level of HRQoL compared to the general healthy population. US born participants (n = 97) reported poorer psychological QoL and social relations, more somatic symptoms, and were more likely to be depressed than non-US born participants (n = 89). Higher numbers of somatic symptoms were associated with poorer environmental QoL. Depression was associated with all aspects of QoL; a higher level of depression was related to poorer QoL in all aspects. Our findings show that free clinic patients, especially US born patients, have poor HRQoL. Depression and perceived neighborhood satisfaction are key factors to determine HRQoL among free clinic patients. Mental health services and collaboration with other community organizations may help in improving HRQoL among free clinic patients. Finally, health promotion programs at the community level, not just at the clinic level, would be valuable to improve health of free clinic patients as perceived neighborhood environment is associated with their HRQoL.