Medical Residency Rotation Preference Form
Submit your rotation preferences, availability, and relevant background to assist with scheduling your upcoming medical residency rotations.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Residency Program
*
Please Select
Internal Medicine
Pediatrics
Surgery
Obstetrics & Gynecology
Psychiatry
Emergency Medicine
Family Medicine
Other
Residency Year
*
Please Select
PGY-1
PGY-2
PGY-3
PGY-4 or above
Preferred Rotation Blocks (Rank your top 5 choices)
*
Rows
Rank 1
Rank 2
Rank 3
Rank 4
Rank 5
Cardiology
1
2
3
4
5
Gastroenterology
6
7
8
9
10
Endocrinology
11
12
13
14
15
Hematology/Oncology
16
17
18
19
20
Nephrology
21
22
23
24
25
Pulmonology
26
27
28
29
30
Infectious Diseases
31
32
33
34
35
Neurology
36
37
38
39
40
ICU/Critical Care
41
42
43
44
45
Emergency Medicine
46
47
48
49
50
General Surgery
51
52
53
54
55
Other
56
57
58
59
60
Please indicate any dates you are unavailable for rotations (e.g., vacation, conferences, exams)
List any rotations you have already completed
Are there any special requests or restrictions that should be considered?
Please select your preferred rotation locations (choose all that apply)
Main Hospital
Community Clinic
Outpatient Center
Affiliated Hospital
Other
Additional Comments or Information
Submit Preferences
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