OD/Emerg and Radiology Session Change Request

OD/Emergency and Radiology Session Change Request
This form is to be used by students wishing to cancel a clinical session, switch a clinical session with another student, or book a makeup session in the OD, Emergency or Radiology Clinics.

Please note:

Before you use this form, please ensure you follow proper protocol outlined by the Student Services Office for reporting absences.
Your Information
Your year*

DDS-3DDS-4
Change request type*

Cancel a sessionMake up a sessionSwitch a session*
*Ensure you have your colleague's consent and group information before you request a switch. If you can't find a replacement, you must notify Dr. Kim (DDS-4) or Dr. Black (DDS-3) at least 2 weeks in advance. (No need to notify Dr. Kim or Dr. Black if you do have a replacement)
Name*

First NameLast Name
Email address*
Your section number*
Clinic*

Oral DiagnosisEmergencyRadiology
Cancelled session details
Cancelled session date

DayMonthYear
Cancelled session time

AMPM
Makeup session details
Makeup session date

DayMonthYear
Makeup session time

AMPM
Colleague you are switching with
Colleague's Name

Colleague's First NameColleague's Last Name
Colleague's email address
Colleague's section number
Session switch details
Your original session date

DayMonthYear
Your original session time

AMPM
Your new session date

DayMonthYear
Your new session time

AMPM
Your Confirmation*

By clicking this box you confirm that you have followed the proper protocol outlined by the Student Services Office for reporting absences.
Should be Empty:

OD/Emergency and Radiology Session Change Request

Your Information

Cancelled session details

Makeup session details

Colleague you are switching with

Session switch details