Medical Mission Application

/Medical Mission Application
Medical Mission Application2018-08-30T14:19:12-04:00

Please fill out or view the Medical Mission Application below.

Check out our “FUTURE MISSIONS

Download our PDF check list on what to bring for your trip, click here “PACKING CHECK LIST

The Doctors’ Goodwill Foundation is dedicated to helping others with their Missions. Please review the following forms and submit your request either by faxing the form to 321-633-8374 or emailing it to [email protected]

Mission Form – If you are part of a mission, you may qualify for financial help up to $500.

Supply & Equipment Request – This form may be used to request medical supplies and equipment needed for your mission. It should be submitted along with the “Mission Details” form.​

Mission Details – Please fill out this form when requesting supplies/equipment or if you would like us to publish details of your mission on our Web Site.

Follow-up Mission Report – This report is to be completed after your mission and is required for recordkeeping purposes.

Receiving Physician Report – This report is to be completed by the “receiving physician” at the site of your mission to verify that they have received the supplies/equipment donated by the DGF.

  • Name Of Medical Organization:

  • Applicate must submit the following information:

    1. Letter of Recommendation - Medical Mission Chairman.
    2. Volunteer Work Experience
    3. Doctors' Goodwill Foundation Participation (if any)
    4. Name of DGF member(s) known by applicant (if any)