Tele Mobile Clinic Volunteer Interest Form
This sign up sheet merely shows interest in getting involved with the Tele Mobile Clinic initiative and not a full commitment.

Volunteers must be either:
(1) UIHC staff medical providers MD, DO, PA, NP, etc
(2) Students on clinical rotations: Med/PA/DNP/2/3/4

Step #1: fill out this interest form
**Step #2: sign-up for a shift:

**Specialty staff (ex: OB/Gyn, pediatrics, ortho, etc) only need to complete step #1 and do not need to sign up for a shift. You will be emailed the day before if there is a patient with a complaint related to your specialty if you're available/willing to help staff.

Joyce Wahba
Call/text: (408)510-2225
First and Last Name *
Email *
Cell phone number *
What additional languages do you speak?
Please only mark off languages that you are fluent or advanced in. You must be comfortable conducting a medical interview in this language.
What is your role? *
***If UIHC staff, what is your role and department? (ex: MD in Family Medicine, PA in Internal Medicine, etc)
***If UIHC staff, what roles are you comfortable with? (Mark all that apply)
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