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Suitcase Clinic - Volunteer Survey
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Contact Information
First Name
Last Name
Phone
Email Address
How do you prefer to be contacted?
Email
Phone
In what capacity would you like to volunteer?
Licensed healthcare professional: medical provider (PA, NP, MD, DO), nurse (LPN, RN), Counselor, Dentist, Optometrist, Podiatrist, Social Worker, PT
Database development
Social media coordinator
Great Community Give organizer
Clinic/office helper (non-medical tasks)
Other
Your Availability
Please note the times that you would be available and willing to volunteer:
Monday morning clinic 9AM-12PM
Monday evening clinic 4-6PM
Tuesday morning clinic 10AM-12PM
Wednesday evening clinic 6:30-9:00PM
Non-clinic time (to be arranged individually)
Please note any pertinent skills or training:
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