Wayne State University

Revised Standardized Patient Information Form

KADO CLINICAL SKILLS CENTER
The Standardized Patient Program

Please  Note:  
We ask a number of questions regarding  your demographics and health history. Any information provided will be used  to help match you with appropriate case scenarios. All Information will be kept confidential.

 

Demographic Information

Past Experience

Disclaimer and Consent

Please mark each day and time you would currently be available to work. Please only
mark times when you ARE available.