Please complete this application form if you are interested in becoming a CarePoint Clinic volunteer. By state requirements all in-clinic volunteers must be fully vaccinated.
Once you complete the form, click the Continue button at the bottom. Someone will contact you with next steps.
This is only used to help us get a better idea of the demographic make-up of our volunteers.
Please provide what volunteer position you are applying for
Please list your availability for volunteering
Please provide us with your current employer information and length of employment. If not currently employed, enter "N/A" in the required (*) fields.
Please list professional skills that would be useful for clinic volunteering
Medical volunteers must list current medical license numbers for verification. If you hold a medical certification, we can still utilize you as a front desk volunteer
Do you have any active involvement with the Medical Board regarding your practice? Are there any practice limitations on your license right now?
All medical professionals are required to have malpractice insurance that covers their volunteer work. Please indicate carrier and expiration date:
Free malpractice insurance for volunteers is available at
People come from many faiths to volunteer. Are you willing to work with people whose beliefs may be different than yours? If you are affiliated with a faith community, please provide name.
Please provide 2 references with at least one of these having knowledge of your professional experience.
Have you ever been convicted of a crime? If yes, please explain.
CarePoint Clinic will run a background check prior to volunteering. Please provide your maiden name and/or any previous name you've used.