Healthcare Worker Survey

Healthcare Worker Survey

This brief questionnaire is your first step in exploring possibilities—no obligations, no pressure. It simply helps us understand your heart for ministry and how we can best support your journey in medical missions.
Personal Information
First Name*
Last Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name of Your Church*
City*
ST*
Denominational Affiliation*
Professional Training
What is your healthcare profession?*
Do you have any specialty training or special area of focus?*
How many years have you practiced in your profession?*
Missions Interest
Have you ever engaged in a cross-cultural experience outside the US?*
Which types of international involvement interest you? (check all that apply)*

Praying for a specific healthcare-related workGiving to a specific healthcare-related workLong-distance consultation in your area of expertise with an international workerShort-term mission trips in which you focus primarily on practicing in your field (1-4 weeks)Short-term mission trips in which you focus primarily on teaching in your field (1-4 weeks)Extended-stay mission trips focused on teaching or practicing (1+ months)Mentoring current international workers or nationals in other countriesOther
What medical areas are you most interested in supporting? (check all that apply)*

Primary Care OutpatientPrimary Care InpatientMaternal HealthPediatricsSurgeryPublic HealthNursing EducationCommunity Health NursingDisaster ReliefDental CareCounselingPhysical TherapyOccupational TherapyVision CareSpeech PathologyOther
Which area of the world interests you the most?*

AsiaMiddle EastAfricaCentral / South AmericaEurope
How much time could you potentially commit? (check all that apply)*

Regular video consultations1-2 weeks per year for visitsLonger-term commitmentsOther
Do you have any language skills that might be helpful in international settings? Please list them.
What would you hope to gain from this partnership?*

Cross-cultural medical experienceTeaching opportunitiesLearning about global health challengesMission field exposureOther
Rank the following barriers for you to participate in a short-term missions trip where 1 = no barrier, and 5 = a very serious barrier.

Time constraints *
Financial constraints *
Family constraints *
Job constraints *
Other constraints *
Would you be interested in learning more about specific opportunities?*

YesNo
Do you have any other comments or questions?
Should be Empty:

Healthcare Worker Survey

Personal Information

Professional Training

Missions Interest