Observership and Hands-on Request Form for IMGs
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Do you prefer virtual or in-person?
*
What specialty are you going into?
*
Would you like us to find an observership for you? Consultation and Placement Fee is $550.
Yes
No
You may select your preferred geographical location and medical specialty from the options below, and we will work on finding a suitable observership opportunity for you.
Connecticut — Internal Medicine
Virginia — Family Medicine
Minnesota — Internal Medicine
Maryland — Internal Medicine
Minnesota — Family Medicine
Other
How did you hear about us? Thank you for reaching out
*
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If you have any questions, feel free to reach us via WhatsApp at 6129138196.
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