Family Medicine Clerkship Preceptor Availability Form

We're recruiting for clerkship preceptors for the Class of 2023, clerkship placements during the academic year 2022-2023. Incoming clerks will be resuming the 4+4 Family Medicine Clerkship Block rotation starting in February (4 weeks Urban + 4 weeks Rural). Fill out the table below with the number of clerks you feel you can take per block. Please note that clerks will attend a site for 4 consecutive weeks. 

Physician Information
Please provide us with your contact information and a few details about your clinic. 
Do you currently have a CSM faculty appointment?
Would you be interested in running small group academic sessions?
Small group academics will typically be on Thursday mornings, in person at the Health Science Centre. If you select yes, we will reach out to provide you more information and confirm your availability. 

Block Availability
Please list the number of clerks you are able to take under each block

Learners will be off for Summer Break between Jul 4 - 10, 2022

Learners will be off for Winter Break between Dec 19, 2022 - Jan 1, 2023


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