San Juan County COVID-19 Public Health/Medical Volunteer Registration Form
Use this form to submit initial information for islanders with medical license, certification, or public health investigation experience who are potentially interested in supporting the County COVID response. Note that this is just an information gathering tool, and may not lead to actual deployment as a volunteer.
Your Last Name
Your answer
Your First Name
Your answer
Email
Your answer
Best Telephone Number
Your answer
What Island do You Live On?
Choose
Orcas Island
Lopez Island
San Juan Island
Shaw Island
Outer Island
What Skills/Licenses do you Posses?
Public Health Experience (Contact Tracing, etc.)
RN
Fluent Spanish Speaker
PA
MD
Operations/Logistics Expertise
Paramedic
EMT
Other Medical Care Provider
Emergency Responder
Other:
Please indicate if any of the following are true:
I consider myself to be in a high risk category for COVID-19
I am willing to potentially collect specimens, provide patient care, or work in a facility or in close proximity with COVID-19-infected patients.
Briefly describe your particular area of interest/expertise or any other key info:
Your answer
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