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Procedure Trainer - Surgical Suturing
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Date Selection:
Wednesday Afternoon, April 26, 2023 3:00pm - 5:00pm
Name *
Full Name.
Work Email *
Campus Address *
Work Telephone *
Department *
Please choose one
Anatomy & Cell Biology
Anesthesia
Biochemistry & Molecular Biology
Biostatistics
Cellular & Integrative Physiology
Dermatology
Emergency Medicine
Family Medicine
Interdisciplinary/Other
Internal Medicine
Medical & Molecular Genetics
Microbiology & Immunology
Neurology
Neurosurgery
Obstetrics/Gynecology
Ophthalmology
Orthopedics
Otolaryngology
Pathology & Laboratory Medicine
Pediatrics
Pharmacology & Toxicology
Physical Medicine & Rehab
Psychiatry
Radiation Oncology
Radiology & Imaging Sciences
Surgery & Surgical Subspecialties
Urology
Rank/Title *
Role *
Please choose one
Faculty
Fellow
Resident
Other Role
Other Role if necessary
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? *
Yes
No
Additional Notes
(e.g. special considerations for scheduling)
Name of Clinical Assistant/Scheduler
Please note: clinical assistant/scheduler will be copied on confirmation email.
Clinical Assistant/Scheduler Work Email
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