Emergency-Clinic

If you are a clinic or other agency which needs help  from volunteers, please complete the following contact form.  We will get back to you as soon as we can. [contact-form][contact-field label=’Clinic or Agency Name’ type=’text’] [contact-field label=’Contact Name’ type=’text’ required=’1’/][contact-field label=’address’ type=’text’/] [contact-field label=’Email’ type=’text’ required=’1’/][contact-field label=’Message’ type=’textarea’/] [contact-field label=’Please type:  “Emergency”‘ type=’name’/][contact-field label =’Please type: “emergency@bipolarbears.org”‘ type=’email’/][/contact-form]