Driver Request- General Doctor's Appointment
Friday, October 21 2022
Date of Appointment: 10/21/22
Appointment Time: 8:00am
Pickup Address: 4513 Regal Ridge Dr, Apt 3116. Fort Worth 76119
Facility and Doctor Name: Rodeo Dental (3330 Mansfield Hwy #B, Forest Hill, TX 76119)
Documents Needed: ID, Medicaid
Car Seats Needed? (located at the Fort Worth office) No
Estimated time of entire appointment: 1.5hrs 
Full Client Name (s), Gender and Birthday: Taiba Shah Mahmood, F, 6/17/2004
Case number: HB-129947
How Many Adults/Children: 1 adult
Case Worker name and number for volunteer questions: Noelle Foster, 817-936-0591. If client feels ok after appointment, she will need to be dropped off at Success HS.
Volunteer’s Notes from the appointment:
Contact the event organizers:
            Email
            *
          
					
				
            Password
            *
          
					
				
            Confirm Password
            *
          
					
				
            First Name                          *
                      
                      
          				
            Middle Name                      
                      
          				
            Last Name                          *
                      
                      
          				
            Intern                      
                      
            
          				
            Phone Number                          *
                      
                      
          				
            Address Line 1                          *
                      
                      
          				
            City                          *
                      
                      
          				
            State                          *
                      
                      
          				
            Zipcode                          *
                      
                      
          				
            Church                      
                      
          				Message to Organizer
            
          