| Department of Anesthesiology

UNC Anesthesiology – Attending Shadowing Request Form

We’re excited you are interested in shadowing with UNC Attending Anesthesiologists. Please complete the form below to start the process and allow us to plan your future shadowing experience. NOTE: Operating Room (OR) shadowing is typically limited to one day to accommodate all requests. Shadowing in the OR typically starts at 6:30am and ends early afternoon, at the latest. ** Due to high request volume for shadowing with Attending Anesthesiologists, there may be delays in scheduling shadowing experiences. We appreciate your patience as we work to accommodate requests as best we can. **

This field is for validation purposes and should be left unchanged.

Name(Required)

First & Last

Email(Required)

Phone(Required)

Date of Birth (MM/DD/YYYY)(Required)

UNC / Other Affiliation (Please check one)

Undergraduate - UNC

Graduate - UNC

Undergraduate - Other Institution

Graduate - Other Institution

UNC School of Medicine Employee

UNC Health Employee

International Clinician

National Clinician

Other

If Other, Name Title or Position(Required)

Current Program of Study / Job Title & Institution (eg, UNC-CH undergraduate, Chemistry major):(Required)

Background & Goals(Required)

Please provide a short 3-5 sentence summary of your background and goals for shadowing.

Dates(Required)

Please list 2-4 future weekdays (Mondays - Fridays / no weekends ) you are available to shadow. Please allow THREE WEEKS to process all steps necessary to fulfill requests.