Medical Providers Volunteer Requirements
Medical Provider Volunteers
Professional Medical Volunteer Providers must obtain and submit the following forms:
- Review the CFPB Summary of Rights document. Sign the Acknowledgement and Authorization for Background Checks. Provide to the Leahy Community Health and Family Center. You must understand your rights prior to submitting for Federal and State Clearances.
- Volunteer Provider Initial Application
- Statement of Fitness/Medical Clearance PPD
- or
- Instructions for how to complete this clearance can be found on page three of the PDF.
- Instructions & service code to complete the
- Volunteer License Application --
Nursing/Pharmacy/Other Healthcare Providers
- Volunteer Nursing/Pharmacy/Other Initial Application
- Statement of Fitness/Medical Clearance PPD
- or
- Instructions for how to complete this clearance can be found on page three of the PDF.
- Instructions & service code to complete the
- Volunteer License Application --
Physical Therapy Volunteer Providers
Physical therapy providers interested in volunteering must obtain and submit:
- or
- Instructions for how to complete this clearance can be found on page three of the PDF.
- Physical Therapy Provider Initial Application
Contact Us:
570-941-6112
Location:
230 Kressler Court
51做厙, PA 18503
230 Kressler Court
51做厙, PA 18503
Mailing Address:
Leahy Clinic
800 Linden Street
51做厙, PA 18510-4699
Leahy Clinic
800 Linden Street
51做厙, PA 18510-4699
Instagram: @theleahycenter