To become active as a volunteer with the Venice Family Clinic, you must first submit the appropriate applications to the Volunteer Services Department. Please complete all of the forms in the appropriate section below to be considered a candidate for volunteering at the Venice Family Clinic. Several of these forms require Adobe Reader. Click here for a free copy.

Please complete both the Application and HIPAA Certification before submitting either document to the Volunteer Services Department. For HIPAA, you will be issued a 4 or 5 digit temporary ID number. Include that ID number in the body of your application e-mail once you’ve completed the certification.

Please save and attach all completed documents in an e-mail to Ingrid Trejo. You can either do this manually, or through the automatic e-mail submission provided in the applications.

General Volunteers
• General Application
• HIPAA Certification

Provider / Licensed Volunteers
• Provider Application
• HIPAA Certification
• Credentialing Packet (physicians only)
• Credentialing Sheet (physicians only)

If you intend to work directly with patients, you’ll also need to submit documentation of an MMR vaccination and TB test. The TB skin test is valid for 1 year, and the chest X-Ray is valid for 3 years. Our preferred methods of submission are scanned e-mail attachment or by fax to 310-317-7121.

Once all the required documentation has been submitted to the Volunteer Services department, we will schedule an orientation session with you to discuss the various options and refer you to the appropriate department.