Expert Enrollment Form - Sudanese American Medical Association

عيادة ساما الالكترونية

Click here to learn about the SAMA E clinic

First Name *

This is how it will appear on the announcements

Last Name *

This is how it will appear on the announcements

Speciality *

Limited specialities in trial phase of this program

Position/Academic Rank *

chooose one rank (e.g. Professor or Consultant - not both)

Name of Institution/Hospital/University *

Choose one affiliation to be included in the announcements

City/State *

Country *

Email Address *

e.g. +249912345678

Confirmation of SAMA responsibility to maintain Expert anonymity *

I understand that SAMA will maintain my anonymity and will NOT share my personal information with the patient/surrogate

Attestation of Expert Responsibilities *

I understand that I am expected to render an expert opinion within 72 hours of receiving the information & that I attest to maintaining patient/surrogate anonymity and not share any of their personal information.