Temple Peer Support Network Sign Up

Temple Peer Support Network Sign Up

Sign up here if you are willing to be available as needed for a 20 minute confidential phone call to a colleague who needs support.
Please note: The Temple Peer Support Network (PSN) is a wellness initiative to promote camaraderie and connectedness between providers. It is a peer support program, not a mental health program. Participants who identify a mental health need to their peer support person will be directed to access mental health services through the employee assistance program (EAP) by calling 1-800-437-0911.
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
I agree to be available to call a colleague who needs support within 2 days of receiving notification. *

Agree
Age

20-40 years old 41-60 years old >61 years old
Gender

Man Woman Transgender/Nonbinary Prefer Not to Answer
Role

Resident - intern Resident - mid or senior Fellow APP (PA, NP etc) faculty - assistant professor faculty - associate professor faculty - professor
Department

anesthesia internal med internal med subspecialty family med emergency med surgery - general/trauma surgery - subspecialty neuro neurosurgery OB/GYN ophtho ortho ENT PM&R podiatry psychiatry radiology urology pathology
Times available to make a call (choose all that apply):

day evening nights flexible
Please leave any other comments about your participation here:
Should be Empty: