Faculty of Medicine & Dentistry
Student Professionalism Concern Reporting Form

This form should be used for reporting concerns only and should not be used for emergencies.

All forms will be reviewed in as timely a fashion as possible, and triaged according to level of urgency.

Please summarize the events of the concern including details such as:

  • Nature of the concern
  • Names of all individuals involved EXCEPT PATIENTS
  • Precise time and location
  • Whether you experienced the concern yourself or witnessed someone else experiencing it

Please note: The events of the concern must be made in good faith and to your best recollection of the concern. Filing of a false, frivolous, retaliatory, vexatious, or malicious report will be considered a professionalism lapse.

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