Please only complete this form if you are a licensed medical professional and interested in volunteering at Church Health. If you are not licensed, please complete the appropriate volunteer form for other areas. It is the responsibility of the health care volunteer to maintain active licensure and malpractice insurance. If the provider does not carry his/her own malpractice insurance, and is retired from practice other than at Church Health, he/she can request to be carried on our group Church Health malpractice policy.
Once you complete the form, click the continue button at the bottom of the page.
Upon completion of the application, please email any malpractice insurance information and your DEA number to the Volunteer Coordinator.
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