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Introducing Online Healthcare Services and Online Financial Services

We value you as a patient. And we value your time. That’s why we’re thrilled to introduce you to our new online services – secure online bill-pay and financial account management along with access to online healthcare services.

By creating your account(s), you can simply and securely:

Request appointments
Complete medical history forms
Pay a bill online

To create your online account(s), we need a little information from you.
Call us today at 507.287.2780 to get started!

It’s fast. It’s easy.
It's your healthcare on your time.

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Volunteer Application

General

*Last Name	*First Name	Middle name
*Address		P.O. Box / Apt. #
*City	*State	*Zip / Postal Code
*Phone Number	Cell Phone Number
*Email Address		Date of Birth (mm/dd/yyyy)*

Family Members Employed or Volunteering at OMC

Name	Department
Name	Department

Employment/Volunteer Experience

*Are you currently employed? Yes No	Number of Hours per week?
Employed By	Job Title / Description
Please give a brief description of any current or previous volunteer work you have done

Emergency Contact

*Name	*Relationship To You	*Phone Number
*Name	*Relationship To You	*Phone Number

Availability

*Please give a brief description of your availability, including days of the week available, number of hours per week, and time of day.

References

Please note that references will be checked, and your application process is not complete until we have completed references back.

Name		Relationship To You
Address		P.O. Box / Apt. #
City	State	Zip / Postal Code
Phone Number	Email Address

Name		Relationship To You
Address		P.O. Box / Apt. #
City	State	Zip / Postal Code
Phone Number	Email Address

Terms and Conditions

Confidentiality Statement

All information concerning patients, families, and employees must be held in strict confidence. There should be no discussion of patients' names/cases or other information regarding their visit to an OMC clinic or hospital with any person.

I have read and understand the above statement regarding confidentiality and agree to abide by it. I understand that a violation of the policy is grounds for dismissal.

Statement of Health

I agree that I am in good health and do not have any restrictions which may result in injury to myself or cause illness to others.

I understand that people with highly contagious diseases (airborne spread) and moderately contagious disease (person to person, through food, or hands-on contact spread) must refrain from volunteering for 24 hours after the last symptom has disappeared.

Support for Mission of Olmsted Medical Center

I agree to support the mission, vision, and core values of Olmsted Medical Center through my volunteer service, and will adhere to the high standards for caring, quality, safety, and service established by Olmsted Medical Center.

*Initials (Please enter your initials to acknowledge that you have read and agree to the above statements)

Areas of Interest

Please check the boxes that are an area of interest for you to volunteer at OMC.

OMC Pink Ribbon Mentors

Volunteers must be breast cancer survivors and commit to one year of service.

If you have any questions, please call 507.287.2790.

OMC Spirituality Volunteers

Volunteers must commit to one year of service.

If you have any questions, please call 507.529.6806

Please check which spirituality duties you are interested in (Please check all that apply)

Communion	Prayer
Spiritual Counseling	Baptism
Last Rights	Other
Please specify other

OMC Auxiliary Information

Active members are required to volunteer a minimum of 15 hours a year, independent of meeting attendance. There are no volunteer requirements for Sustaining and Honorary members.
Annual dues: $5.00
If you have any questions, please call 507.529.6868

Please check the types of volunteering that are of interest to you.

Sewing group (sewing, crafts, quilting, etc.)
Coffee cart (serving coffee, muffins, and juice to patients' families)
Gift Shop (working in the gift shop, stocking shelves, working the cash register)
Bazaar and Events (helping with setup, making items for the sale)
Hand Massage Therapy (providing hand massages for patients and their families)
Blood drives (handing out juice and cookies to donors)
Still Missed Garden maintenance (weeding and grooming the garden)
Committees (willing to serve on small committees)
Greeter or Escort Service (assisting in patient care facilities to direct patients and families)
Other; Interests or Skills:

Other Volunteers

Service commitments are dependent on the specific job to be performed.

If you have any questions, please call 507.292.7202

Please specify other

Please check if appropriate

I am able to work independently without supervision

I am restricted to lifting Pounds