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Community Health Center Board (CHCB) Interest Form
The CHCB provides guidance and oversight to Clinic Services, the County of Monterey's health centers, that provide high quality healthcare to patients regardless of ability to pay.
1.
Please provide us with your contact information.
First Name
Last Name
Street Address
City and Zip
Phone number
Email address
2.
Do you currently live or work in the County of Monterey or a surrounding area?
Live
Work
Both
Neither
3.
Are you a patient of the County of Monterey Health Department Clinics?
Yes
No
4.
If yes, which clinic? If no, select "not a patient"
Laurel Family Practice / Laurel Vista
Laurel Internal Medicine
Laurel Pediatric Clinic
Alisal Health Center
Seaside Family Health Center
Marina Clinic
NIDO Clinic
Not a patient
5.
Why are you interested in serving on the Community Health Center Board?
6.
Are you willing and able to attend monthly meetings?
Yes
No
7.
Thank you for your interest in serving on the CHCB. A Clinic Services staff member will follow up with you to provide more information.
Please tell us how you prefer to be contacted below.
Phone
Email
