As the COVID-19 pandemic progresses, leaders at Massachusetts hospitals are seeking volunteers from our biotech industry with all levels of experience and training willing to pitch in. 

If you are interested in volunteering – we need you! Whether you have any clinical training (physicians, nurses, pharmacists, etc) or could help in non-clinical aspects of healthcare – you are welcome. Please consider filling out this survey to indicate your willingness to be called upon to volunteer should the need arise.

We are collecting the information through the form linked below in order to make this information available to health care officials, hospitals and others who may, in their discretion, be interested in contacting you for your potential assistance, and will not be disclosed by us for other purposes unless required by law.  This information will be maintained by us for this purpose and will be disclosed by us only in connection with these activities.  We will maintain this information for as long as we believe it to be useful in connection with the potential provision of these services.  If you would like us to remove your information please contact us at info@lifesciencecares.org.  

By submitting your responses, you understand that you are providing information on this website for the possibility of offering to volunteer your services knowingly and willingly, and that filling out the survey does not commit you to a volunteer engagement. The final decision on whether/when/how to volunteer will be between you and the hospital. You also acknowledge and agree that you knowingly and voluntarily waive, irrevocably release and discharge Life Science Cares and its officers, directors, agents, employees, parents, affiliates, subsidiaries, successors and assigns from and against any and all claims, causes of action or demands relating to or arising out of your doing so, including, but not limited to, any claims related to workplace exposure to COVID-19.   

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* 1. Contact Information

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* 2. Geographic Availability: Check all that apply.

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* 3. Availability: Days of the Week

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* 4. Availability: Time of Day

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* 5. How are you prepared to help?

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* 6. Training

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* 7. Degree Completed?

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* 8. For MD's, residency completed?

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* 9. For PharmD's, residency completed?

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* 10. For Nurses, any specialty?

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* 11. Currently practicing?

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* 12. How many years experience practicing?

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* 13. If no, how many years of training completed?

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* 14. Current/Active Massachusetts License?

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* 15. Other state of licensure?

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* 16. Please list any medical specialty. (Ex: anesthesia, cardiology, neurology, etc.)

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* 17. Please list any special skills. (Ex: critical care, peripheral line placement, procedural skills, feeding tubes, stroke management, etc.)

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* 18. How can you help? (Medical/clinical volunteers can skip.)

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* 19. Is there anything else you'd like to add?

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