Simulated Patient Applications For full details of the sessions, please see this page. ΔFirst Name Last Name Email Phone/Mobile Age (real, not playing age) Where will you be traveling from?City How do you currently mostly identify? - Select -MaleFemaleNon BinaryPrefer not to statePrefer to self identifyGender Identity Minimum Playing Age Maximum Playing Age Tell us about yourself (optional) Upload Headshot Choose File Upload CV (optional) Choose File If you have a website or link you would like to share, please add it here I confirm I am registered as self employed with HMRC YesHave you taken part in medical communication skills role-play before? Yes NoPlease describe your experience in communication skills role-play Have you self-facilitated communication skills sessions before? Yes NoPlease describe your self-facilitation experience I can attend an audition on the 1st of June at the Derby Royal Hospital Yes No I consent to have this website store my submitted information so they can respond to my inquiry I have read and agree to the Terms and Conditions and Privacy PolicySubmit Application
