Client Number * PSU Team * Careers Unit Coaching Service Individual Support Team Adviser Name * Adviser Email Address * Identified Reasons for Applying: * Progression with Training: Clinical Concerns Progression with Training: Examination Failure Progression with Training: Misconduct Progression with Training: Behavioural Difficulties (other than misconduct) Health Problems: Physical Health Problems: Psychological (including substance misuse) Work Environment Issues: Bullying Work Environment Issues: Harassment Work Environment Issues: Other Systemic Problems Personal Circumstances Other Than Ill Health: Bereavement Personal Circumstances Other Than Ill Health: Relationships Personal Circumstances Other Than Ill Health: Other Non-work Related Issues Careers Concerns: Specialty Choice Careers Concerns: Career Direction Careers Concerns: Leaving Medicine Careers Concerns: Work-Life Balance Careers Concerns: Flexible Working Other: Dyslexia Other: COVID-19 Other: Not specified in list above Other: Confirmation * By clicking here you will confirm that you have accepted the terms of our privacy statement. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Submit
