California Health Care Professionals Volunteer  Form
This form is to help the local HEALing community medical coordinator to match medical cases with physicians and hospitals willing to donate care for Gaza children. Thank you for joining our humanitarian efforts.
Email *
Name *
Primary Phone number *
Secondary Phone number
Preferred method of communication
 *
Required
Location (s) — City/County  *
Work/Office Address
 *
Specialty  *
Current position held *
Are you interested in treating medical cases locally or abroad?
 *
Provide names of Hospitals, Clinics and Surgery centers that you are affiliated with and or currently working at? 
 *
Are you open to giving advice when needed on a child’s case?
 *
Can you provide free facilities for a child’s medical care?
 *
Please share additional comments, affiliations, questions or concerns below. Thank you! 
 *
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