Register - Future Doctors Academy

Registration Form

Please fill in the form below to register.

First Name *
Last Name *
Use proper capitalization as this is how it will appear on your certificate should you choose to become certified.
Email *
Confirm Email *
Are you part of the Envision Experience?
Yes
Your Current Phase *
Field of Interest
e.g. GP, Dental, Nursing, Physician Assistant, EMT, Physiotherapy, Pediatrics, etc)
Where did you find out about Future Doctors' Academy?
e.g. Facebook, friend, or whatever...
I already have an Apprentice Doctor Simulation Kit
Check this if you were directed to this website after acquiring one of the Apprentice Doctor Simulation Kits
Username *
Password *
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