Standardized Patient Availability Form

First Name*

Last Name*

E-mail address*

Availability Information*

I am travelling/working/busy with other projects and will not be available for some time.

I have a specific schedule and am only available on specific days/times of the week.

I am not interested in or comfortable simulating this role.

Request to be made inactive (have secured full time employment, moving to another Country/Province, no longer available for other reasons)

Other

Please provide return date

Please specify the specific days/times of the week when you are available:

Please list the role

SPP will update your profile so that you will no longer be contacted for this type of role.

Please specify

CAPTCHA

Math question (2 + 5 =)*

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.