Clinical Surgical Training Center

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+971 6 5585000

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SSI Patient Volunteer

Name

Phone Number

Phone

Emirates ID No

Passport No

Name of the course

Course Date (Day/Month/Year)

Your Interest in the SP Program

Please choose for which program you are interested to become a simulated patient

Select an option

Please choose (Pregnant/Non-pregnant)

Select an option

Other Programs

Medical history (Please list any current/past medical conditions)

Please tell us why you are applying to become a simulated patient

Simulated Patients are needed for physical examinations. Are you comfortable while a healthcare professional examines you?

Select an option

Availability

During which days and hours are you available?

Select an option

Session

Select an option

Upload Passport/Emirates ID(document attachment – jpeg, pdf, word etc.)

Attach The Abstract

Upload File

Note: Please bear in mind that Simulated Patients are hired as needed, based on educational courses that are being conducted at our center. We will contact you as soon as a course appropriate for you arises.