Take Action

Please answer these brief questions and email your medical license and proof of insurance to alex@sfcityimpact.com. (You may also hand-carry your medical license and proof of liability when you come to orientation.)  You should receive a reply from one of our Medical staff or Alex Quock, City Impact's Volunteer Coordinator, in three days or less.  Please feel free to contact SF City Impact with any questions at (415) 292-1770 during business hours or email Alex Quock at alex@sfcityimpact.com. If you are needing to speak directly to the clinic please during business hours call (415) 738.6878. 


Volunteer Form


Name *
Name
Birthdate
Birthdate
Phone
Phone
Address
Address
Are you volunteering as an individual or a team?
Does your current liability insurance allow you to work outside your current practice?
Are you willing to do home visits alongside designated City Impact staff or volunteers if asked?