LAMA Form

LAMA Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Citizenship*
Academic status*
University*
If your university is not listed please type it here
Graduation date*

DayMonthYear
Date
Services*

Clinical Rotation (LORs)USMLE Step1USMLE Step2 CKRoad to ResidencyResearchVisa AssistanceHousing Assistance
USMLE step1 price
USMLE step2 CK price
Malpractice insurance price
RTR price
Visa Assistance calculations
Research price
Rotation price
Discount
How many rotations (LORs) needed?*
Rotation 1*
Rotation 1 type:*

OnsiteOnline
If other Please specify
Rotation 1 duration (per weeks)*
Rotation 1 start date*

DayMonthYear
Date
Rotation 1 Price
Rotation 1 Malpractice
Rotation 1 Calculations
Rotation 2 *
Rotation 2 type:*

OnsiteOnline
If other Please specify
Rotation 2 duration (per weeks)*
Rotation 2 start date*

DayMonthYear
Date
Rotation 2 Price
Rotation 2 Malpractice
Rotation 2 Calculations
Rotation 3*
Rotation 3 type:*

OnsiteOnline
If other Please specify
Rotation 3 duration (per weeks)*
Rotation 3 start date*

DayMonthYear
Date
Rotation 3 Price
Rotation 3 Malpractice
Rotation 3 Calculations
Rotation 4*
Rotation 4 type:*

OnsiteOnline
If other Please specify
Rotation 4 duration (per weeks)*
Rotation 4 start date*

DayMonthYear
Date
Rotation 4 Price
Rotation 4 Malpractice
Rotation 4 Calculations
Rotation 5*
Rotation 5 type:*

OnsiteOnline
If other Please specify
Rotation 5 duration (per weeks)*
Rotation 5 start date*

DayMonthYear
Date
Rotation 5 Price
Rotation 5 Malpractice
Rotation 5 Calculations
Rotation 6*
Rotation 6 type:*

OnsiteOnline
If other Please specify
Rotation 6 duration (per weeks)*
Rotation 6 start date*

DayMonthYear
Date
Rotation 6 Price
Rotation 6 Malpractice
Rotation 6 Calculations
USMLE Step1 Course Date*

MonthDayYear
Date
USMLE Step1 duration (per weeks)*
USMLE Step1 Calculations
USMLE Step2 CK Course Date*

MonthDayYear
Date
USMLE Step2 CK duration (per weeks)*
USMLE Step2 CK Calculations
Housing start date*

MonthDayYear
Date
Add your notes
Should be Empty: