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COVID-19 Clinician Resource Request Form

Complete the following information indicating your need for clinicians during the COVID-19 pandemic.

Once your request form is received indicating your needs, it will be added to a resource bank to be matched with clinicians who have volunteered. 
  • We are sourcing both in-person and telehealth opportunities.
  • Once matched, individual hospital systems/sites will be responsible for screening and allocating qualified volunteers (including any required paperwork for licensing, etc).

This question requires a valid email address.
This question requires a valid number format.
Does your system have a point person who will be contacting matched clinicians?
Who is the point person?