QUESTIONNAIRE FOR A VOLUNTEER MEDICAL WORKER
If you are a doctor, nurse or other health worker and want to help Ukrainian hospitals provide assistance to victims of war, please fill out this form:
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First name *
Last name (Surname) *
Year of birth *
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/
DD
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YYYY
Country of residence *
Degree of education *
Specialty by diploma *
Specialization *
Mobile phone number *
E-mail address *
Do you speak the Ukrainian language? *
Do you speak the Russian language? *
During what time could you provide assistance in Ukraine: *
Choose the region of Ukraine in which you are ready to assist: *
Required
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