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Office of the RegistrarElective/Extended Clinic Registration Form Elective Clinic: A student may take any clinic as an elective, including a clinic they have previously taken as a required clinic,
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How to fill out electiveextended clinic registration form
How to fill out electiveextended clinic registration form
01
Start by writing your personal details such as your name, date of birth, and contact information in the designated fields.
02
Provide your medical history by accurately filling in any past illnesses, surgeries, or allergies you may have.
03
Indicate the reason for your visit to the electiveextended clinic and the specific department or doctor you wish to consult.
04
If you have insurance, provide the details of your insurance policy, including the insurance company's name, policy number, and contact information.
05
Complete any additional sections or questions that may be specific to the electiveextended clinic, such as emergency contact information or consent forms.
06
Review the entire form to ensure all information is accurate and complete.
07
Sign and date the form to attest that the information provided is true and correct.
Who needs electiveextended clinic registration form?
01
Anyone who wishes to receive medical services or consultations at the electiveextended clinic needs to fill out the electiveextended clinic registration form. This form helps the clinic gather relevant information about the patient, their medical history, and contact details for proper record-keeping and communication purposes.
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What is electiveextended clinic registration form?
Electiveextended clinic registration form is a form used to register for clinics that are not required for graduation but are taken by choice.
Who is required to file electiveextended clinic registration form?
Students who wish to take electiveextended clinics must file the registration form.
How to fill out electiveextended clinic registration form?
To fill out the form, students must provide their personal information, select the desired clinics, and obtain approval from their academic advisor.
What is the purpose of electiveextended clinic registration form?
The purpose of the form is to officially register students for electiveextended clinics, ensuring that they receive credit for their chosen courses.
What information must be reported on electiveextended clinic registration form?
The form typically requires information such as student name, student ID, selected clinics, and advisor approval.
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