All fields with an asterisk (*) are required. Thank You The form was submitted successfully. 2023-CORP-GME-Concerns-PI Please fill in a valid value for all required fields Please ensure all values are in a proper format. Are you sure you want to leave this form and resume later? Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form. Save and Resume Later Save and get link You must upload one of the following file types for the selected field: There was an error displaying the form. Please copy and paste the embed code again. Apply Discount You saved with code Submit Form Submitting Validating There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue. Please check the field: Fields Resident/Fellow State* Please select California Colorado Florida Georgia Idaho Kansas Louisiana Missouri Nevada New Hampshire North Carolina South Carolina Tennessee Texas Utah Virginia Which Hospital in California? Please select Los Robles Regional Medical Center Riverside Community Hospital Other Which Hospital in Colorado? Please select Presbyterian/St. Luke's Medical Center Sky Ridge Medical Center Swedish Medical Center The Medical Center of Aurora Other Which Hospital in Florida? Please select HCA Florida Aventura Hospital HCA Florida Bayonet Point Hospital HCA Florida Blake Hospital HCA Florida Brandon Hospital HCA Florida Citrus Hospital HCA Florida JFK Hospital HCA Florida Kendall Hospital HCA Florida Largo Hospital HCA Florida North Florida Hospital HCA Florida Northside Hospital HCA Florida Northwest Hospital HCA Florida Oak Hill Hospital HCA Florida Ocala Hospital HCA Florida Orange Park Hospital HCA Florida Osceola Hospital HCA Florida Palms West Hospital HCA Florida Plantation Hospital HCA Florida St. Lucie Hospital HCA Florida St. Petersburg Hospital HCA Florida Trinity Hospital HCA Florida West Hospital HCA Florida Westside Hospital HCA Florida Woodmont Hospital Plantation General Hospital Other Which Hospital in Georgia? Please select Coliseum Health System Memorial Health Memorial Satilla Health Other Which Hospital in Idaho? Please select Eastern Idaho Regional Medical Center (EIRMC) West Valley Medical Center Other Which Hospital in Kansas? Please select Menorah Medical Center Overland Park Regional Medical Center Wesley Medical Center Other Which Hospital in Louisiana? Please select Rapides Regional Medical Center Tulane Medical Center Other Which Hospital in Missouri? Please select Lee's Summit Medical Center Research Medical Center Other Which Hospital in Nevada? Please select MountainView Hospital Southern Hills Hospital & Medical Center Sunrise Hospital and Medical Center Other Which Hospital in New Hampshire? Please select Portsmouth Regional Hospital Other Which Hospital in North Carolina? Please select Mountain Area Health Education Center Other Which Hospital in South Carolina? Please select Grand Strand Medical Center Trident Health Other Which Hospital in Tennessee? Please select TriStar Centennial TriStar Skyline TriStar Southern Hills Other Which Hospital in Texas? Please select Conroe Corpus Christi Heart Hospital Corpus Christi Medical Center Doctors Regional Del Sol Medical Center Kingwood Las Palmas Medical Center Medical City Arlington Medical City Fort Worth Medical City Plano Medical City Weatherford St. David's South Austin Medical Center West Other Which Hospital in Utah? Please select St. Mark's Hospital West Other Which Hospital in Virginia? Please select LewisGale Hospital Montgomery LewisGale Medical Center Other Which "other" hospital? Resident/Fellow Program I have already addressed my concerns with: Program Director Designated Institutional Officer GME leader Hospital Human Resources Other: Other Value Comments/Concerns* Resident/Fellow Name If you prefer to speak with someone at the GME Corporate Office, you may reach out directly to Jennifer McDonell, HR Manager & Deputy Title IX Coordinator, at (702) 830-0753. Thank you for allowing us this opportunity to listen. Previous← Next→ Enter your save and resume password Cancel Confirm
