Volunteer Registration
Please fill out the form below to register as a volunteer for Kintegra.
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Volunteer Type*
Provider
Non-Provider
Basic Information*
Credentials*
Doctor of Medicine (MD)
Doctor of Optometry (DO)
Doctor of Medical Dentistry (DMD)
Doctor of Dentistry (DDS)
Nurse Practitioner (NP)
Physician Assistant (PA)
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Medical Assistant (MA)
Registered Dental Hygienist (RDH)
County to Volunteer*
Catawba
Davidson
Forsyth
Gaston
Iredell
Lincoln
Volunteer Timeframe*
Special Skills/Interests*
Other Volunteer Activities
Sponsoring Organization
Facility
Education*
High School
9th
10th
11th
12th
College/University
Freshman
Sophmore
Junior
Senior
Graduate
Reference*
Fields of Interest*
Pharmacist/Tech
Clerical
Answer Phones
Pick Up/Delivery
Data Entry
Other
Days Available*
Monday
Tuesday
Wednesday
Thursday
Friday
Time Preference
Morning
Afternoon
Evening
How did you learn about Kintegra?
Volunteer Expectations*
Cooperation & Flexibility
Quality patient care takes a team effort. You may be asked to “fill in” for a missing staff person or to help in an unfamiliar task when needed. You may be able to offer suggestions on your work that can ease time and effort requirements. Immediate patient needs may call for a change in routine. Try to meet temporary challenges and changes with a “can-do” attitude.
Initiative
While everyone works to a different tempo, your job has specific tasks that must be started and finished on time. There are many “unassigned” jobs that also need to be done when you are not quite so busy. Ask your supervisor if you feel you need additional training for your position or if you see a job that makes sense as part of your daily routine
Patient/Staff Relations
The patients are the reason you are here. Your dealings with them should always be courteous and calm, whether in person on or the telephone. Deal with other staff members in the same way. Ask your supervisor for help if conflicts arise.
Demeanor & Dedication
Not every day is a good day. Employees should always try to maintain a positive outlook in front of patients and other staff members, as well as an enthusiasm for the job. Be proud of the place you work. If you’re unhappy with a situation, talk to your supervisor. Don’t just complain to co-workers, or worse, do this where patients can overhear you.
Dependability
Your job is essential – and other staff members depend on your performance to do their own jobs. Arrive and leave on time. Let your supervisor know if you have a need to be out of the office during the day. Don’t take planned time off without filling out the necessary paperwork.
Organization
Prioritize your work so that your team mates can also accomplish their jobs. Focus on the task so that it can completed quickly and competently. Look for ways to do your job better.
Productivity
Use the time you have in the best possible way. Ask for help if you need it. Your work speaks for you to others. Make it say something good.
Quality Improvement
Participate in quality improvement activities for Kintegra.
Agree with the terms and conditions
Volunteer Statement of Confidentiality*
I promise to hold in confidence all information regarding patients of Kintegra/Community Health Partners/HealthNet Gaston. I will not violate the confidential relationships between the organization, its clientele, staff and volunteers. I will not remove from the office any written records or copies thereof. Any written records I may be responsible for producing shall be and remain part of the organizational files.
I accept full responsibility for maintaining the confidential and private nature of all records and information. I further understand that I can discuss patients only with my designated supervisor and/or designated administrator.
Agree with the terms and conditions
Volunteer Confirmation of Age*
I am at least 18 years old.
Register
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THANK YOU!
Thanks a bunch for filling that out.
It means a lot to us, just like you do!
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