Please enter your legal last name (family name / surname). This will be the name assigned to procedure logs and used for verifications in the future.
Please enter your first name (given name).
Please enter a middle name. This can be left blank. Hint: If you have a common last name (family name), the middle name can help clarify your identity for verification purposes.
Program
For trainees, this is the specific training program that you are currently enrolled and logging procedures. Note: If you plan on further training after the current program is complete, ProcedureLogs can change the program when appropriate after verification. For program administrators, select all of the programs that you currently officiate.
Date Starting This Role
Enter the date that you started (or will start) this role in the program. Note: Do not count pre-clinical training years (laboratory time or non-accredited training). For trainees, this should be the date of the start of your clinical training.
Date of Expected Completion of this Role
For trainees, this is your expected date of completion of clinical training. For program officials, this can be left blank.
Institution
This is the institution that the training program is based. If your institution is not shown on the dropdown list. Please pick individual and enter the name of the institution below in the comments section that you would like us to contact to verify your enrollment.
Specialty
This is the overarching medical specialty for the training program.
This can be used for alternative account and two-step verifications.
See above. Enter comments for the ProcedureLogs team. Please type the name of the institution you wish to be affiliated with and the program director name and contact information. Your account cannot be activated until your participation in the program is verified.
Contact settings
Allow other users to contact you via a personal contact form which keeps your email address hidden. Note that some privileged users such as site administrators are still able to contact you even if you choose to disable this feature.
Your face or professional picture. Providing a photo will personalize your profile and allow quicker procedure log verification in the future. Note: This photo will be attached to official procedure logs and verification documents in the future. | One file only. | 1.46 MB limit. | Allowed types: png gif jpg jpeg. | Images must be larger than 200x200 pixels.
CAPTCHA
Image CAPTCHA
Enter the characters shown in the image.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.