CPR Training Form

I am interested in being a member of  TIC’s Lifesaver Team.

NAME:  ____________________________________

ORGANIZATION: ____________________________________

ROOM # _________________    

TELEPHONE #_________________

Please return completed form to the Medical Office in suite 241.

The Medical Office is located on the Second Floor in the Interchurch Center in Room 241.

The current staff of the medical office is:

· Carlton Boxhill MD, Medical Director and Consultant

· Abby T. Druckner RN ANP, Nurse Practitioner and Coordinator of Clinical Practice

· Odessa Mathews RN

· Patricia Jackson, Administrator

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Medical Office News

Automatic External Defibrillator and CPR Training

I am interested in Automatic External Defibrillator and CPR Training.

NAME:  ____________________________________

ORGANIZATION: ____________________________________

ROOM # _________________    

TELEPHONE #_________________

Please return completed form to the Medical Office in suite 241.

FLU AND PNEUMONIA SHOTS

 

TO: The Interchurch Center Medical Office

Room 241

 

I, ______________________, would like to be scheduled for an appointment for:

(PLEASE PRINT)

 

           ____(1)         Influenza Virus Vaccine immunization

 

           ____(2)         Pneumococcal Vaccine immunization

 

           ____(3)         Both the Influenza Virus Vaccine and the                                                                                               Pneumococcal Vaccine immunizations

 

I can be reached at the following telephone number ___________.