Volunteer Form
Registration for the Health Fair for Volunteers
Email address *
First & Last Name *
Your answer
Phone Number *
use this format xxx-xxx-xxxx
Your answer
Who are you affiliated it with? *
Other Organization
Your answer
Are you volunteering individually or with your organization?
Did you volunteer at the health fair last year?
What best describes you?
If Medical Student
If you are Physician/Resident, please indicate your specialty
Other
Your answer
Time available *
Select one or more responses
Required
Language Needs *
Indicate your comfort level with your Spanish verbal skills. We will have a Spanish Medical Interpreters available)
Required
How would like to help?
(We will attempt to place you in your first choice. Please select ONLY one first choice, one second choice and one third choice)
First Choice
Second Choice
Third Choice
Registration
Medical Interpreter
BMI - weight & height
Check Blood Pressure
Lab (Glucose and cholesterol) screening station
Perform Paps (This will be held at a different date/location that will be announced later)
Perform Clinical Breast Exams (only)
Check vision and hearing
Assist providers during exams
Assist with Pediatric station
Assist in Teddy Bear Clinic
Assist with HIV station
Assist with Colorectal screening station
Assist with Dental screening station
Vaccine station
Skin station
Provide recommendations of health results (only Physicians and Residents)
Health Education
Assist with children's activities (games and playground)
Set up/Clean up crew
Traffic/Safety/Crowd controler
Hospitality (Food Station)
Volunteer/Information Station
Assist with opening a Personal Health Record
Assist with Urology Station
Assist with Cardiovascular Station
Assist with GRITS (shot record check/input data)
IT Support/data entry
Do you have a recommendation, idea to make this health fair successful?
Your answer
Do you have any suggestions on what health education or health screenings we can offer or who other individuals/organizations we should contact for volunteering and participating in the health fair?
Please provide a contact name and phone/email for potential volunteers
Your answer
Thanks! We are looking to an amazing health fair!
Please join Portal de Salud in Facebook and Tweeter pages. We will be posting news about the health fair and try to keep everyone updated through the social media.
A copy of your responses will be emailed to the address you provided.
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