MOLA Disaster Relief Services
MOLA is coordinating with the City of Chicago to provide a list of resources available to evacuees from the natural disaster in Puerto Rico.
Please note that the current expectations are that evacuees will be coming with “no financial or insurance resources” and will not be able to pay for services rendered. Payment and available monies in the future will be completely dependent on a Disaster Declaration and registering evacuees with FEMA for disaster assistance funds.
Email address *
Name of person completing form *
Your answer
I am interested in opportunities to assist evacuees with health/medical issues in Chicago.
What services would you/your clinic or hospital be able to provide for evacuees?
How many evacuees per month would you be able to assist with the above services? OR how many hours per month could you offer?
Your answer
Contact person at clinic/hospital
Your answer
Contact phone number at clinic/hospital
Your answer
Name & Location of clinic/hospital
Your answer
Would you be interested in potentially participating in medical mission trips to areas in need from recent natural disasters (e.g. Puerto Rico)? *
Please let us know if you have any additional feedback.
Your answer
A copy of your responses will be emailed to the address you provided.
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