Which of the following areas would you be willing to volunteer in? (Please check all that apply)
Please include a copy of the requested documents below. These are kept on file for insurance/auditing purposes.
Physicians must send a copy of the cover sheet with the amount of coverage and policy number of their current medical malpractice insurance. This is used until you are vetted for the Federal Tort Claims Act medical malpractice insurance. This is in addition to a medical license which is also required for insurance/auditing purposes
As a condition of volunteering, I give permission to the FernCare Free Clinic to conduct a background check on me. I hereby release and agree to hold harmless from liability the FernCare Free Clinic, the employees and volunteers hereof or any other person that may provide such information. I also understand that the FernCare Free Clinic is not obligated to appoint me to a volunteer position. If appointed, I understand that I am subject to suspension and removal for violation of FernCare Clinic policies and procedures.