Skip to content

Site header and navigation

Book Appointment MyChart Pay Bill Donate

Find a Location
Find a Provider
Services
Patient Info
About Us

Book Appointment

Find a Location
Find a Provider
Services
Patient Info
About Us

Book Appointment MyChart Pay Bill Donate

Adult Volunteer Application

Adult Volunteer Application

Premier Community HealthCare Group, Inc. — 37912 Church Avenue, Dade City, Florida 33525

Personal Information

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

Date of Birth

Last 4 of SSN (for background check)

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Relationship

Volunteer Preferences Preferred Location Days/Hours Available Special Skills or Interests Why do you want to volunteer at Premier?

Signature

By signing below, I certify that the information provided is true and accurate. I authorize Premier Community HealthCare to conduct a background check.

Signature (type your full name)

Date

📄 Download PDF Version

Need help? If you have difficulty using this form, please call (352) 518-2000 for assistance. Phone requests may experience longer wait times than using the form above.

Site footer

About Us +

Patient Rights
ADA Compliance
Privacy Policy (PDF)
Terms of Use
Transparency in Coverage

Get Care +

Book Appointment
Find a Location
Find a Provider

Support Us +

Get Involved
Donate

Connect +

Contact Us
Careers

352-518-2000 727-645-4185 352-567-0218 fax

Copyright © 2026 Premier Community HealthCare Group, Inc.

Premier Community HealthCare Group, Inc. is a Health Center Program grantee under 42 U.S.C. 254b and is deemed a Public Health Service employee under 42 U.S.C. 233(g)-(n) with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. For more information, you may contact our corporate office at 352-518-2000 or visit https://www.bphc.hrsa.gov/ftca/.