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.Format: (000) 000-0000.
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)

Other
What medical areas are you most interested in supporting? (check all that apply)

Other
Which area of the world interests you the most?
How much time could you potentially commit? (check all that apply)

Other
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?

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

Personal Information