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MedHub Support
MedHub Support Ticket
Please submit the support ticket below for MedHub Support
(i.e., Incoming MS1-MS4 Years)
MedHub PRECEPTOR PROFILE ADDITION REQUEST
MedHub PRECEPTOR PROFILE ADDITION REQUEST
Please provide the following information if you would like to request the addition of a preceptor's profile to MedHub so that you may initiate an ad hoc Evaluation about/to them
Your Name
*
First
Last
Your Email Address
*
Are you requesting a profile for more than one preceptor?
*
Yes
No
Preceptor Name
*
First
Last
Credential (ex. MD, NP, PA, PhD)
Preceptor BU Email Address
If there is a "bu.edu" email address applicable for this preceptor, please provide above
Preceptor Preferred Institutional/Work Email Address
*
Preceptor email address must be an institutional email (e.g. University, Hospital). Gmail, Yahoo, and similar personal email addresses will not be accepted.
Preceptor Rank
*
Resident Educator
Attending
Clinical Rotation
*
Emergency Medicine Clerkship Selective
Family Medicine Clerkship
Geriatrics Clerkship
Medicine 1 Clerkship
Neurology Clerkship
Obstetrics/Gynecology Clerkship
Pediatrics Clerkship
Psychiatry Clerkship
Radiology Clerkship Selective
Surgery Clerkship
Ambulatory Medicine - Clinical Elective
Surgery Subspecialty – Clinical Elective
Other
Please select the Clinical Rotation you would like this preceptor to be available for.
Clinical Rotation (Other)
Location of Clinical Rotation
*
Please enter the Preceptor's clinical rotation site/location name.
If you have more than 1 Preceptor Profile to request at one time, please use
this template
and upload below.
If there is a "bu.edu" email address applicable for this preceptor, please provide.
Preceptor preferred email address must be an institutional email (e.g. University, Hospital). Gmail, Yahoo, and similar personal email addresses will not be accepted.
File
Additional Information?
SUBMIT A MedHub SUPPORT TICKET
SUBMIT A MedHub SUPPORT TICKET
Your Name
*
First
Last
Your Email Address
*
MedHub Support Need:
*
Please describe your MedHub Support Need in detail and include all relevant information. If necessary, please include Module/Course/Rotation name, Block, Site Name, and Student/Faculty Names & Faculty Rank (Resident Educator/Faculty).
File
File
File
Please allow 3-5 business days for service requests to be processed and resolved.
