Regional PODs Medical Prescriber Volunteer Form

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Please answer the questions below in order to volunteer at one of the Regional PODs being run by RI municipalities. Note that by answering this survey you will not necessarily be called upon to volunteer at a Regional POD. Thank you for your willingness to serve.

Email *

Please write your name: *

Please provide what medical license you hold in Rhode Island? Note that while all volunteers are welcome, we are specifically seeking individuals with prescribing privileges (e.g MD, DO, PA, NP, etc.) at this time. *

Please provide a phone number where you can be best contacted. *

Please provide a general description of the days/times you are available to volunteer (e.g. weekdays after 5PM, weekends all day, etc.) *

Please indicate which Regional POD you would prefer to volunteer in or select "No Preference" if you are willing to volunteer at any. *

Northern POD (located north of Providence, exact location will be provided to those who volunteer)

Capitol POD * HIGHEST NEED* (located within Providence, exact location will be provided to those who volunteer)

Southern POD (located in Washington County, exact location will be provided to those who volunteer)

Mid-State POD (located in Kent County, exact location will be provided to those who volunteer)

East Bay POD (Located in Bristol County, exact location will be provided to those who volunteer)

No preference

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