Event Sign Up Sheet | Track It Forward

Driver Request- General Doctor's Appointment

Thursday, August 18 2022

Date of Appointment: 8/18/2022
Appointment Time: 2:30
Pickup Address: 2313 Galleria Drive Apt. 5408, Fort Worth, TX 76119

Facility and Doctor Name: JPS Family Health Center, 4th Floor

Documents Needed: ID, Medicaid card
Car Seats Needed? (located at the Fort Worth office) No
Estimated time of entire appointment: 2-3 hours

Full Client Name (s), Gender and Birthday: Abdul Rafique, Male, 9/20/1954; Khatema Rafique, Female
Case number: HB- 150112
How Many Adults/Children: 2

Case Worker name and number for volunteer questions: McKenna Hansen, 817-449-0397

Volunteer’s Notes from the appointment: The two know where to go and how to check in. They just need to be dropped off at JPS and then dropped back off to their apartment.

2:30pm - 4:30pm
Driver
JPS Appointment
0 / 1

Contact the event organizers: