Request/Referral for Assistance

All members of the medical community (practitioners, professional staff, patients and fellow students) are invited to complete this form in the event of a significant concern about a medical student that you consider should be managed by the UQ Faculty of Medicine.

It may concern the student's academic progress, conduct and behaviour, and/or general welfare. The concern will be directed to the relevant staff member/s, and the student offered appropriate support and counselling.

Your report will have no direct bearing on the student's academic progress.

This webform replaces the earlier form known as a "Notice of Concern".

Student you are concerned about

Your Details (referring person)

*Category of Concern
*Summary of Concern
*Have your concerns been discussed with the student or a staff member from UQ or Qld Health?

CRICOS Provider Number 00025B