Simulation Centre Enquiry FormEnquiry form Name Name of Course Director * Role * Place of Work * Phone Number * Email Address * Course / Training Title * Course / Training Details Preferred Date * Start & End Time * (usual opening hours 08:00 - 17:00) Which rooms do you require? * Anaesthetic Room Debrief Room End Ward Main Ward Theatre (Find our floorplan on The Centre page) Number of Delegates attending * Are delegates attending... * UH Bristol & Weston employees External delegates Mixture of UHBW & External Staff groups attending * Dental Hygienist Dental Nurse Dental Student Dentist Doctor Medical Student Non-Clinical Nurse (registered) Nurse (non-registered) Nursing Assistant ODP Other Allied Health Professional None of the above Number of Faculty attending * Do you require a Sim Technician to help with manikins and equipment? * Yes No Do you require any of your course to be recorded for debriefing or educational purposes? * Yes No (If Yes, it is your responsibility to ensure consent has been given by all candidates and faculty involved) Are you running single or multiple scenarios at a time? * Single Multiple Are the scenarios for Adult or Paeds? * Adult Paediatric Both Any additional information (If you know what specific equipment or manikins you require, please state it here) If you have details of your scenarios, please upload these here Add Files Please confirm you have read and agree to our Privacy Policy * I agree Please see link to Privacy Policy below Please confirm you have read and agree to our T&Cs * I agree Please see link to T&Cs below Privacy PolicyRead our Privacy PolicyTerms and ConditionsRead our Terms
