Community Outreach • Community Benefit

Northwest Community is seeking dental professionals to participate in our Mobile Dental Clinic. For additional information, contact Nancy Colovos, Program Manager of the Mobile Dental Clinic, at 847.618.5572.

• How Can You Contribute Towards This Project?
  We are asking you to donate 4 - 8 hours of your valuable time every month/quarter to provide care for the underserved and give back to the community in a meaningful way. For those who are unable to volunteer their time at the clinic we are asking you to accept no-charge referrals from our clinic into your practice.
• How will Northwest Community support you if you become a part of this project?
  All volunteer providers will have professional liability provided by Northwest Community Hospital.
• Only truly poor people will qualify for services
• If you want to accept referrals, we will refer only the number of patients you want per month. (Example: 1 per month or as per your request)
• Public recognition for services

• Volunteer Application and Interest Form
  If you are a dental professional wishing to apply for participation in this program or for more information, please download the following form and fill in, as applicable.

This document requires Microsoft Word.
Northwest Community Mobile Dental Clinic Volunteer Application Form. You may complete the form electronically and save and print, or print out the blank form and complete it. The form may be mailed to:

Northwest Community Hospital
Attn: Mobile Dental Clinic
3060 Salt Creek Lane
Arlington Heights, IL 60005
or faxed with a copy of your license to:
847.618.4273
Attn: Nancy Colovos