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INTEREST
SURVEY

HOWYOUHELP

Fillable PDF Version

Interest Survey form for Medical/Dental/etc.

Compassion Evangelical Hospital of Guinea

First name*

Last name*

Email*

Phone

Area of Medical Interest/Training

Area of Medical Interest/Training*

General Medicine

Surgery

Pediatrics

Emergency Medicine

Nursing

Mental Health

Public Health

Other

Availability: Please indicate the time frame you are interested/available.*

Preferred Volunteer Role:

Multi choice*

Direct Patient Care

Administrative Support

Health Education

Community Outreach

Research Assistant

Other

Relevant Experience:

(Please briefly describe any relevant medical or volunteer experience) *

Languages Spoken:*

Are you a licensed healthcare professional? *

Yes

No

If yes, please specify your credentials:

Additional Skills:

(Please list any additional skills that may be relevant)

Contact Us.

ADDRESS

Compassion Evangelical Hospital
P.O. Box 870

Southfield, MI 48037

PHONE

1- 877 948 8729

Email

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YouTube

Instagram

Link to local Mamou, Guinée website

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MIAPE Guinée Facebook

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INTEREST SURVEY

Contact Us.

ADDRESS

PHONE

INTEREST
SURVEY