• Admissions Application

    Admissions Application form for Buckhead School of Medicine. Use the attached logo. Preserve the exact labels and field types specified in the request.

  • Applicant Information

  • Format: (000) 000-0000.
  • Birth Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: 000-00-0000.

  • Program and Education History

  • Start date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Graduation date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Employment History

  • Start Date (Employment)
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date (if not employed)
     - -
    2 digit month, 2 digit day, 4 digit year

  • Application Essay

  • Commitments and Disclosures

  • Can you commit to 32-40 hours a week for school and clinicals?*
  • Can you arrive to class and clinicals on time?*
  • Can you keep patient records confidential according to the HIPAA policy?*
  • Do you have access to wifi or ethernet internet for online/distance education classes?*
  • Are you disciplined to participate in online/distance education classes?*
  • Do you have a smartphone?*
  • Do you consent to SMS (text) messages from Buckhead School of Medicine?*
  • Do you have a laptop or PC computer with camera and audio speakers?*
  • Do you give Buckhead School of Medicine permission to post your social media feedback/post that you post on the school's website, Google, Yelp, or social media platform?*
  • Do you give Buckhead School permission to share posts on all social media outlets?*
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  • Upload Files
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  • Upload Files
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  • Application Fee (Non Refundable Application Fee)*

    prevnext( X )
    USD

    Payment Methods

    creditcard
    After submitting the form, you will be redirected to Apple Pay to complete the payment.
    After submitting the form, you will be redirected to Google Pay to complete the payment.
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