Health/Medical Questionnaire

If there is any question or statement on this form that you do not understand, ask for assistance by calling Cindy Smith, Vice President, Operations at Health Force of Georgia: 770-458-8500 ext. 704.

Thank you for completing the caregiver career application at Health Force of Georgia. There are three sections to the Health/Medical Questionnaire form. Be sure to complete ALL sections before clicking submit. The form will prompt you if there is required information missing in any section. Fields marked with a red * are required.