KCMedBridge Physician Shadowing Program Application

KCMedBridge Physician Shadowing Program Application

Thank you for your interest in our shadowing program. This is a great opportunity to gain firsthand experience in a clinical setting and learn from experienced physicians. Please complete the application form to help us match you with the right physician and clinic. If you have any questions, feel free to contact us at contact@kcmedbridge.org.We look forward to helping you advance your medical career! Best, KCMedBridge Team.
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Birth Date*

MonthDayYear
Date
Grade (Highschool)*
What is your current GPA?
Emergency Contact*
What are you currently involved in?
Are there specific days or times that you are available or not available for shadowing? (afterschool, etc). *
At most two sentences.
Have you taken any relevant course or training related to medicine or healthcare? (past experience not required). *
Why are you interested in pursuing a shadowing experience with a physician?*
What specific areas in medicine are you interested in and why?*
Do you have any questions or concerns about the shadowing program?*
By participating in the shadowing program organized by KC MedBridge, you acknowledge and accept the inherent risks of observing clinical practices. You agree to release and hold harmless KC MeBridge, its officers, and affiliates from any liability for personal injury, loss, or damage resulting from your participation. KC MedBridge is not responsible for any incidents that may occur during your shadowing experience.

You agree to adhere to all rules, regulations, and guidelines established by the clinic or physician you are shadowing, including maintaining confidentiality and following safety protocols. Failure to comply with these rules may lead to immediate termination of your participation, and such non-compliance will not be the responsibility of KC MedBridge.

KC MedBridge does not provide insurance coverage for participants, and it is your responsibility to obtain any necessary personal health or liability insurance. KC MedBridge reserves the right to amend these Terms and Conditions and to terminate your participation at any time for any reason. Continued participation constitutes acceptance of any updated terms.
Volunteer Candidate Signature*

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Thank you for completing your application for the KCMedBridge Physician Shadowing Program Application

We appreciate your interest and will review your application carefully. Should you have any questions in the meantime, please reach out to us at contact@kcmedbridge.org.

Best of luck!

KC MedBridge
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