UHBW Simulation Centre

Simulation Centre Enquiry Form

Name of Course Director *

Job Role *

Place of Work *

Email *

Phone Number / Bleep *

Course Title *

Preferred Date *

Start & End Time *

Number of Delegates Attending *

Number of Faculty Attending *

Are Delegates Attending *

Staff Groups Attending *

Do you require a Sim Technician to help with manikins and equipment? *

Do you require any of your course to be recorded for debriefing or educational purposes? *

(If Yes, it is your responsibility to ensure consent has been given by all candidates and faculty involved)

What rooms do you require? *

Are you running single or multiple scenarios at a time? *

Are the scenarios for; *

Any additional information?

(If you know what specific equipment or manikins you require, please state it here)

Please confirm you have read and agree to our Privacy Policy *

Our Privacy Policy can be found via the link below this form

Please confirm you have read and agree to our Terms and Conditions *

Our Terms and Conditions can be found via the link below this form

Website

UHBW Simulation Services

UHBW Simulation Centre, Level 5, UHBW Education Centre
Upper Maudlin Street
Bristol
BS2 8AE
United Kingdom