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  • 2019-2020 Intern Longitudinal Clinic Choice Form

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    Dineth Bandarage completed a form indicating their clinic location preferences for their 2019-2020 intern year longitudinal clinic. They listed DHMC in Lebanon, NH as their first choice and Heater Road in Lebanon, NH as their second choice. They also listed the VAMC in White River Junction, VT as their third choice and noted the form was due to be returned by April 5th.

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    19-20 Clinic Choice Form

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    Dineth Bandarage completed a form indicating their clinic location preferences for their 2019-2020 intern year longitudinal clinic. They listed DHMC in Lebanon, NH as their first choice and Heater Road in Lebanon, NH as their second choice. They also listed the VAMC in White River Junction, VT as their third choice and noted the form was due to be returned by April 5th.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    10 views1 page

    2019-2020 Intern Longitudinal Clinic Choice Form

    Uploaded by

    db7717
    Dineth Bandarage completed a form indicating their clinic location preferences for their 2019-2020 intern year longitudinal clinic. They listed DHMC in Lebanon, NH as their first choice and Heater Road in Lebanon, NH as their second choice. They also listed the VAMC in White River Junction, VT as their third choice and noted the form was due to be returned by April 5th.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    2019-2020 INTERN LONGITUDINAL CLINIC CHOICE FORM

    Please return to Mindy.F.Pickett@Hitchcock.org by April 5th

    NAME:____Dineth Bandarage___________________________________

    Please indicate your first and second choice for your longitudinal clinic location below. We will try our best
    to honor your request, but due to space restrictions across sites, we are not always able to accommodate
    every request. Please note that this does not apply to prelims.

    __1__ DHMC (Lebanon, NH)

    __2__ Heater Road (Lebanon, NH)

    _____ Lyme (Lyme, NH)

    __3___ VAMC (WRJ, VT)

    _____ No Preference

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