Event Sign Up Sheet | Track It Forward

Driver Request- TB Clinic Doctor's Appointment

Friday, September 16 2022

Date of Appointment: 9/16/2022
Appointment Time: 10:50am
Pickup Address: 301 Fair Oaks Blvd. #817, Euless, TX 76039

Facility and Doctor Name: TB/ Refugee Clinic

Documents Needed: IDs, Medicaid cards, Shot Records
Car Seats Needed? (located at the Fort Worth office) No
Estimated time of entire appointment: 2 hours

Full Client Name (s), Gender and Birthday:
Shabestan Karimi, F, 11/30/1997
Lamia Karimi, F, 3/6/2018
Sonia Karimi, F, 4/14/2018
Case number: HB-109714
How Many Adults/Children: 1 adult, 2 children

Case Worker Name: Noelle Foster
Case Worker Phone Number: 817-936-0591

Volunteer: Please write your phone number on RSVP
Volunteer: Pick up time may change, pick up volunteer should be flexible

10:50am - 1:00pm
Drop Off
Pick up from home, drop off to Doc
0 / 1
1:00pm - 1:30pm
Pick Up
Pick up from Doc, drop off home
0 / 1

Contact the event organizers: