Thank you for your interest in a clinical rotation at HCC of Rural Missouri and the Live Well Community Health Clinics.  Please fill out the following request form. 

NP, Medical, Dental, PA clinical requests

Undergraduate / Professional Internship Requests

High School / College Shadowing and observation request

The following forms are required ONCE YOUR REQUEST HAS BEEN APPROVED:

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• Student Registration From

• Signed Confidentiality Form

• HIPAA worksheet (attached presentation reviewed)

• School Liability/Insurance Information

• Immunization Schedule with TB

• Background check from school (if available

Please submit all forms to Stephanie Taylor at stephanie@hccnetwork.org

Once approved, please complete the following forms and return to Stephanie Taylor, stephanie@hccnetwork.org