OBSERVERSHIP FORM
FOR PHYSIOTHERAPIST ONLY
YOUR FULL NAME *
YOUR CONTACT NUMBER *
YOUR EMAIL ADDRESS *
YOUR CURRENT CITY *
REASON TO DO OBSERVERSHIP *
YOUR PROFILE CURRENTLY *
HAVE YOU DONE ANY WORKSHOP WITH IIPT *
HOW DID YOU COME TO KNOW ABOUT OBSERVERSHIP PROGRAM *
WHERE DO YOU THINK YOURSELF NEXT YEAR? *
HOW DO YOU KNOW DR. PRACHI SHAH ARORA *
YOUR MONTHLY INCOME *
You are willing to do Observership for? *
How many hours each day would you like to be? *
What training are you interested in Observership? *
Required
NAME THE COLLEGE / UNIVERSITY FOR BACHELORS AND MASTERS PTh YOU GRADUATED FROM. *
YOUR PLAN FOR THIS YEAR *
WILL YOU REQUIRE ACCOMMODATION *
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