Driver Request- General Doctor's Appointment
Monday, October 03 2022
Date of Appointment: 10/3/22
Appointment Time: 10:45
Pickup Address: 4513 Regal Ridge Dr. #3116, Fort Worth, TX 76119
Facility and Doctor Name: JPS Family Health clinic
Documents Needed: ID, Medicaid
Car Seats Needed? (located at the Fort Worth office) No, but client has a wheelchair
Estimated time of entire appointment: 2.5 hours
Full Client Name (s), Gender and Birthday: Hanzalah Shah Mahmood, M, 12/5/2010
Faiz Ullah Shah Mahmood, M, 3/20/1960
Case number: HB-129947
How Many Adults/Children: 1 adult, 1 child
Case Worker name and number for volunteer questions: Noelle Foster, 817-936-0591
Volunteer’s Notes from the appointment:
Contact the event organizers:
Email
*
Password
*
Confirm Password
*
First Name *
Middle Name
Last Name *
Intern
Phone Number *
Address Line 1 *
City *
State *
Zipcode *
Church
Message to Organizer