FCP1 Longitudinal Preceptor

Select Your Visit Dates

Select one date per row for a total of six visits.

Checkboxes inline
Visit 1:
Visit 2:
Visit 3:
Visit 4:
Visit 5:
Visit 6:
Full Name.
Are you currently board certified?

Are you currently board certified?

Do you currently have a faculty appointment with the IU School of Medicine?

Do you currently have a faculty appointment with the IU School of Medicine?

Full Name.
Please note: clinical assistant/scheduler will be copied on confirmation email
Please note that students will be sent in pairs when possible.
(e.g. special considerations for scheduling)