Shadowing Registration Form 2022-2023
We know shadowing opportunities are critically important to career exploration. Please follow these steps once you’ve contacted the physician you’d like to shadow and agreed on a date:

1. Students must register at least one week prior to their date of shadowing to ensure one site is not overbooked.
2. Students must wear PPE at all times, based on recommendation of faculty.
3. Students must not access the medical record.
4. Students must be compliant with BUSM/BMC compliance requirements.
5. Shadowing not permitted during required curricular sessions.
6. Suggested dress: business casual, BUSM ID, and white coat.
7. Patients have a right of refusal. 

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Student Name (First & Last) *
Class Year *
Planned Date of Shadowing *
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DD
/
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Name of Physician to be shadowed *
Name of Department shadowing in *
How shadowing opportunity came about *
Please check box to acknowledge you: have confirmed shadowing with the physician(s), you are compliant with BUSM/BMC compliance requirements, will wear appropriate PPE, will not perform procedures, will not enter patient medical records. *
Required
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