Shadowing Request Form

To begin the process, the requesting shadower must first attain a faculty sponsor. Once attained, it is the responsibility of the requesting shadower to complete all forms listed within the Shadowing Checklist and upload files no later than two weeks before the requested start date. International students or foreign medical graduates must complete all forms no later than sixth months before the requested start date.

Shadower Information

First

Last

E-mail Address

Contact Phone Number

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

UF ID

Please enter your 8-digit UF ID (no dashes)

UF College

UF Department

I would like to Shadow the following faculty member

You will need to contact the faculty member and receive their permission to be observed before completing this form.

I have received permission from the faculty member to observe them

Shadowing Checklist

Before you can submit this form, you must include the provide the following files/information (PDF format required):

HIPAA Training Modules

Please upload a copy of the certificate of completion for your HIPAA Training Modules.
One file only.
5 MB limit.
Allowed types: pdf.

Patient Care Observation Request Form

Please upload a copy with the highlighted yellow sections completed of the Patient Care Observation Request Form.
One file only.
5 MB limit.
Allowed types: pdf.

Photo ID

Please upload a photo of your drivers license. This will be used for photographic identification/verification ONLY.
One file only.
5 MB limit.
Allowed types: pdf.

Security and Confidentiality Agreement

Please upload your security and confidentiality agreement with signature completed.
One file only.
5 MB limit.
Allowed types: pdf.

OR Observation Form

One file only.
5 MB limit.
Allowed types: pdf.

Shadowing Request Agreement

I understand that if approved I will be permitted to shadow one day in clinic and/or one day in the operating room within a calendar year.

I understand the Shadowing Request Agreement as outlined.

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Department of Orthopaedic Surgery and Sports Medicine

College of Medicine

Shadowing Request Form

Shadowing Request Agreement

Department of Orthopaedic Surgery and Sports Medicine

College of Medicine

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