Reference Report: International Medical Graduates: Specialist Pathway

Reference Report

International Medical Graduates: Specialist Pathway
You may submit this form anonymously if you prefer. All information you provide will be treated in confidence.
Referee Name
Applicant Name
Email
example@example.com
Telephone (please include country and area codes)
1. For how long have you known the applicant on a professional basis?
2. Please provide the date and description of your most recent professional contact with the applicant
3. Are there any particular clinical areas in which you feel the applicant may require further training before commencing practice in Australia?
If yes, what are the areas in which you feel the applicant may require training?:
4. Have you been satisfied with the applicant's good standing in relation to their moral and ethical behaviour, and that their professional contact and relationships with patients and staff are of a high standard?
Comment:
5. Are you aware of any adverse findings, restrictions of practice, and limitations in clinical competence about the applicant?
If yes, please comment
6. Do you believe the applicant is suited to practice dermatology independently in a general setting?
Comment
7. Any other comments
I certify that:
Date

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