Faith Clinic Volunteer Form

Please fill out and submit this form. We are glad you are interested in serving at Faith Clinic.

**We are currently only accepting volunteers for provider and pharmacist roles. If you are interested but do not fill one of these rolls, please still submit an application for when positions are available.

Name

*

Address

Phone

*

Email

*

This address will receive a confirmation email

Faith Clinic is currently open Tuesdays from 6:00 pm - 9:00 pm. Does this work for your schedule?

*

Please select one option.

Yes No

What area are you interested in serving in?

*

Please select all that apply.

Front Desk/Patient Intake Nursing Lab Pharmacy Provider Other

If you selected other, please provide more information here.

Do you have any medical training? If so, what type of training?

*

Would you be interested in serving Faith Clinic in any of these other ways?

*

Please select all that apply.

Social Media Special Events Fundraising Donor Appreciation None

Description

Please fill out and submit this form. We are glad you are interested in serving at Faith Clinic.

**We are currently only accepting volunteers for provider and pharmacist roles. If you are interested but do not fill one of these rolls, please still submit an application for when positions are available.

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