Preceptor Availability Form_Residency

Academic Year 2025 - 26

Preceptor Availability Form_Residency

The DLRI office gathers preceptor availability for both the Calgary FM Residency Program and Rural FM Residency Program mandatory core rotations.

Rural and Regional preceptors are a critical part of the postgraduate FM residency programs, their pre-set availability helps determine the schedule for the upcoming academic year.

Please provide your availability below and the number of residents you can precept per block.

*Availability must be given in 2 consecutive block opportunities (no single block increments)

1
Current: General Information
2
Rotation Blocks

Preceptor Name

Name of Practice/Clinic

Email Address

Alternate Email (Personal, Team Lead, Clinic Manager, etc.)

Phone Number

Do you currently have a University of Calgary – CSM faculty appointment?

Yes

Unsure

How do you prefer to be contacted?

Provide pre-set availabilities for specific dates

Being contacted for individual requests as they come up

Not interested in teaching residents at this time

Area of specialty/interest

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.