Confidential Medical Student Comments

Questions marked with a * are required

100%

Date of Comment

Check if your concern needs urgent attention.

Yes, my concern needs urgent attention.

Check if you would like to notify the Dean or Associate Dean/DIO.

Yes, I would like to notify the Dean or Associate Dean/DIO.

Please enter your comment or concern:

Optional Information

Your Name

Are you a UTHSC student?

Yes

Are you and M3 or M4 student?

Indicate to which rotation you are assigned this block.

Enter your email address so we can easily follow-up.