Student Job Shadow Interest Form

  • Student Job Shadow Interest Form

    Thank you for your interest in completing a job shadow experience at Skippack Pharmacy. Please complete the form below to request your visit. Once your date is confirmed, we’ll send you everything you need to prepare for your experience.

  • Student Info

  • Format: (000) 000-0000.

  • Job Shadow Requirements

    If your requested date/time is unavailable, we will reach out to the email or phone number you provided to schedule your experience.

  • Preferred Job Shadow Times with Dr. Mak
    Students who would specifically like to shadow Dr. Mak may select from the following dedicated shadowing times:
    • Tuesdays: 10:00 AM – 6:00 PM
    • Thursdays: 2:00 PM – 6:00 PM
    • Every Other Friday: 10:00 AM – 6:00 PM
    • Every Other Saturday: 10:00 AM – 3:00 PM

    If these times do not work, students may still request a general shadowing experience during the following pharmacy hours:
    • Monday – Friday: 10:00 AM – 6:00 PM
    • Saturday: 10:00 AM – 3:00 PM

  • Would this experience be for a school requirement or personal interest?*
  • First Requested Date*
     - -
  • Second Requested Date
     - -
  • Consent to message with Skippack Pharmacy (via our website chat option OR by texting 267-766-0076)*
  • I consent to photos/videos being taken of me for the purpose of social media usage*

  • Additional Info

  • Should be Empty: