Volunteer Application - Living Well Clinic

Name *

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Last

Email *

Mobile Phone *

Address *

Address Line 1

Address Line 2

City

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Preferred method of contact *

Your Age

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How did you hear about Living Well Clinic? *

What area would you like to volunteer in? *

Primary Care Provider
Medical Support (RN, LPN, PARAMEDIC, EMT, OTHER)
Pharmacy
Intake Specialist (Intake Specialists sit down with each patient and take time to talk to them about their mental and spiritual state, taking time to encourage and pray with each person – Training provided.
Office Staff – Reception, Clerical, Prescription Assistance Experience
Dietician
General Support (Maintenance, Janitorial)
Community Support (Fundraising, Grant Writing, Event Support)

Why do you wish to volunteer at Living Well Clinic? *