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What is your gender?

Do you identify as transgender?

What is your cultural background and/or race? (Choose all that apply.)

Do you have any significant scars, rashes, or tattoos, or conditions such a deafness,  muscle weakness, heart murmur, etc. that would be obvious if a student  examines you? If so describe briefly what can be seen or observed.  PLEASE DO NOT INCLUDE YOUR DETAILED MEDICAL HISTORY.


(We need to ask about any physical findings  that a student might discover while examining you if you are hired  to portray a case that includes a physical exam. All information is kept confidential.)

Do you speak a language other than English fluently?

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