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Thank you for your interest in a shadowing a provider at HCC Network.
Students must be at least 16 years old, parental permission granted, and should be part of a
pre-health profession class, program, HOSA chapter, etc.
Once approved, the following items will be required along with submitting a photo ID.
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Student registration form
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Legal Guardian Consent Form
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Confidentiality Form
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Emergency Contact Form
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Handbook Acknowledgement and Receipt Form
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Policies and Procedures Agreement Form
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Gratuitous Services Form
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TB Form
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Flu Form
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HIPAA training Form
Please print, complete, scan and email forms to Stephanie.taylor@hccnetwork.org.
Please forward any questions or comments to Stephanie at the email above or call 816-617-2353.
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