Preceptor Request Form
Student Precepting and Clinical Rotation services are provided at a $10 hourly rate. A refundable Commitment Deposit of $200 will be charged on the next page upon completing this form.
Be sure not to include personal and private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.
For questions, please contact the office at Info@ellecliniques.com.
Student's Information
Clinical Rotation Details:
Wait for the payment page after you hit the submission button.
Your application will not be processed until your payment is received.