Enclosure (2) to COMDINST 6010.2B
INFORMATION QUESTIONNAIRE for
AUXILIARY HEALTH CARE PROVIDERS
This questionnaire provides information regarding your availability and ability to support CG Health
Care activities
1. Name:
2. Address:
3. Phone number:
4. Auxiliary Member Number, District, Division, Flotilla:
5. E-mail address:
6. Medical/Dental/Nursing Specialty:
7. Are you able to provide to CG Health Care Activities for at least 2 days per month during the
work-week?
8. If so, how many work-week days per month?
9. If a need existed at a CG Health Care activity during an emergency requiring deployment of CG