Healthcare Experience/Observation Form

Below is a link to the Healthcare Experience/Observation Verification Form.  Please submit each experience on its own form UNLESS you've been spending multiple days with the same practitioner in the same location (e.g. you've observed Dr. Smith perform PT on patients at Mercy on 9/2, 9/3, and 9/4).  Be sure you indicate on the form whether or not these have been purely observation or if you have been receiving pay for your experience.

Healthcare Experience/Observation Verification Form