Request an Observation or Consultation Name* First Last Email* Enter Email Confirm Email Phone*Department* Role* Member of TEACH* Yes No Requesting which service: Observation Consultation Requested Observer*Choose here:No preferenceJennifer Cleveland, PharmD, BCPS, MBAChad DeMott, MDMisty Flinchum, BS, RRT -Simulation Observation OnlyMahtab (Mattie) Foroozesh, MDTim Fortuna, DO - Simulation Observation OnlyBruce Johnson, MDAnita Kablinger, MDDaniel Lollar, MDDavid W. Musick, PhDShari Whicker, EdD, MEdTeaching activity you would like observed* Date* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Additional Notes [lmt-post-modified-info]
