Page 1 of 2

FluentMed Free Workshop Request

Prospective institutions may request a pilot session to explore FluentMed’s clinical communication training framework. Pilot workshops are offered on a limited basis to select institutions.

Name of Institution

*

Contact Personnel

*

Email Address

*

Phone Number

*

Location

*

Number of Students/ Faculty For Pilot

*

Language(s) of Origin of Students/ Faculty

*

Pilot Program of Interest

*

Pilot Program of Interest

A

Clinical Communication Workshop for Students

B

Teacher Training Workshop

C

Both

Preferred Date & Time of Workshop

*

Additional Notes/ Comments

*