Clinic Volunteer Form

Clinic Volunteer Form

Use your medical expertise to serve those who might otherwise go without care. Whether you’re a licensed professional or a student in training, volunteering in our clinic helps restore dignity and health—one patient at a time.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Education
Are you currently in school?*

YesNo
What School*
What degree are you seeking*
What is your expected graduation date*
Certifications & Roles*

Nurse AssistantNursing StudentEMTParamedicMedical AssistantNurseChiropractorOptometristOther
Sobering Center Hours

7 Days a week, Starting at 3pm
Availability:

Sobering Center - MondaySobering Center - TuesdaySobering Center - WednesdaySobering Center - ThursdaySobering Center - FridaySobering Center - SaturdaySobering Center - Sunday
Once you have submitted this form, our nurse, Alice McKay, will be in touch with you for an interview.
Should be Empty:

Education