• Doctor Volunteer Sign-Up - Makkah Community Dental Clinic (MCDC)

    Check every Sunday you can volunteer - pick as many as you like. Clinic hours are 8 AM to 2 PM, seeing uninsured and underserved patients who are in pain. Each date takes one doctor; once a date is claimed it disappears from the list. We typically run Sundays — if another provider has already accepted a Sunday, we can schedule patients in for that Saturday as well.
  • Format: (000) 000-0000.
  • What is your scope of dentistry? (select all specialties that apply)*
  • Do you carry dental malpractice (professional liability) insurance?*

  • Good to know: under the Texas Charitable Immunity and Liability Act (Civ. Prac. & Rem. Code §84.004), a licensed volunteer who provides care without compensation through a charitable organization is immune from civil liability for care given in good faith within the scope of their license, as long as the patient signs a written acknowledgment before treatment. The federal Volunteer Protection Act adds similar protection. This is statutory immunity, not an insurance policy, and it does not stop someone from filing a suit, so we still ask about your coverage.

  • Are you medically fluent in any language other than English?*
  • How did you hear about us?*
  • Check every Sunday you can volunteer (8 AM - 2 PM)*
  • Scope of Practice Agreement As a volunteer dentist providing services at Makkah Community Dental Clinic (MCDC), I acknowledge that my practice is limited exclusively to the scope authorized under my current Texas dental licensure or authorization type, and that I will provide services solely as voluntary charity care to eligible indigent or critical-need patients without compensation of any kind. I agree to practice only within the geographic location, time period, and conditions specified by my license or letter of authorization, to follow all clinical protocols, record keeping requirements, and emergency/referral procedures established by MCDC, and to immediately notify clinic administration of any change in my licensure status, disciplinary action, or expiration of my authorization. I understand that practicing outside the scope of my license or after my authorization has expired may constitute the unauthorized practice of dentistry and is strictly prohibited. By agreeing below, I confirm that I have read and understood this scope of practice, and I agree to abide by it for the duration of my volunteer service.
  • Date signed*
     - -
    2 digit month, 2 digit day, 4 digit year
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