Request for Shadowing an HCC Network Provider
Thank you for your interest in shadowing a health professional at HCC Network clinics.  Please complete the following request.  There are no guarantees that shadowing can be arranged but we will try our best to accommodate your requests.

All shadowing requests must be initiated at least THREE weeks prior to the requested shadow date.  Paperwork should be submitted at least one week before the shadow date.

  • Students must be at least 16 years of age or older. 
  • Students younger than 18 must have a legal guardian consent form stating that they can shadow at one of our facilities.
  • Students should be part of a health career class, exploration program, etc.  If not, please tell us why you are interested in health careers.
All students who are shadowing need to have the following immunizations/tests, before shadowing in our clinics:
  • Proof of TB Test within the last year.
  • Flu Shot less within the last year.
Both of these can be obtained a the health department or HCC clinic for a small fee

Once you have submitted a request, the shadowing coordinator will reach out via EMAIL and connect you with the forms that are required and to confirm the shadow date.

If you have questions about shadowing please contact Stephanie Taylor at

Sign in to Google to save your progress. Learn more
First and Last Name *
Email *
Cell Phone *
High School / University *
Current Age and date of birth *
Are you interested in shadowing more than one time?
Clear selection
Dates that you want to shadow (Three week notice is required)
Which positions are you interested in shadowing?  (Click all that apply)
Locations you are willing to shadow (click all that apply).  We cannot guarantee shadowing at specific clinics, opportunities vary depending on provider availability. 
FOR HIGH SCHOOL STUDENTS:  What health career programs are you involved at school or community? (HOSA, PLTW, Health Occupations, ACES, other, etc.)
FOR HIGH SCHOOL STUDENTS:  If you are not involved in any health career class or program, what makes you interested in a health career?   What career fields are you exploring?
FOR COLLEGE STUDENTS:  Are you enrolled in a pre-health track or degree?  If so, what is your major?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy