Shadowing Application

Shadowing Application

Request Form

If you are interested in observing one of our clinicians (providers, or other staff), please complete the form below. Of note, all observers will provide proof of vaccinations and sign the required forms. Those observing for longer than one day have additional requirements such as a health visit with your PCP and online training. Volunteer Services must approve all requests before scheduling a visit. After you have uploaded all required documentation, it may take 15 business days for us to process your application plus the time it takes you to complete the health visit, modules and forms. We will do our best to accommodate your requested dates but that is not always possible.

Observer Last Name*

Observer First Name*

Observer Middle Name (or "none")*

Date of Birth*

Must be at least 16 to observe.

Observer Email*

Observer Phone Number*

Phone

Observer Emergency Contact*

Please list name and phone number.

Department*

Which area would you like to observe? Please note that placements cannot be guaranteed; we will try our best to match you with the area requested. There may be a wait for inpatient PT observations at this time.

Select

Sponsor - a team member at UM Rehab & Ortho who has agreed to let you shadow/Observe

If you do not have a particular sponsor in mind, we can assign one to you based on your interest listed above.

Tell us a little bit about yourself.*

For example, why do you want to shadow? Are you in high school, college or medical school, if so, where and what year? Are you exploring possible careers, etc.

Requested Start Date

Note: it may take 15 business days to process requests; date below should not be less than 15 days from today's date. For those requesting more than one day, there are additional steps (health visit with your physician and online training) which require more time.

Requested End Date

Preferred observation frequency*

For a one-day visit choose "Once (8 hours or fewer)". If you are requesting multiple shadow days, please indicate your preferred frequency (once a week, once a month, etc.).

Select

Preferred days*

Select

File Upload*

Please upload documentation of your vaccinations:

COVID
Flu (Oct. - March)
Varicella
MMR

Once request is submitted, you will receive additional forms (observation, waiver and health forms) by email. Please review, sign and upload here. For those requesting to observe more than 8 hours: health clearance, negative TB test and on-line training are also required.

Drag and drop files here or

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