The Independent Medical Faculty

Phone number – daytime

Phone number – mobile

Email address (NHS) (optional)

Chosen gender

Chosen ethnicity

Names and contact details of two referees who are registered with your Regulatory Body

Specialism (Doctors, Dentists and Retired)

Principal place of work

Current position

Name of qualification, institution, year.

Regulatory body (for example, GMC, GDC, HCPC)

Registration number

Other memberships (for example, RSM, IDF)

Professional indemnity insurance in place?

Yes

Are you willing to mentor juniors or students?

Yes

Are you subject to annual appraisal? (If 'No', skip to 'What can you ...')

Yes

Name of your appraiser

Name of your RO

Which organisation does the RO work for?

Date of your last revalidation

Would you consider having your appraisal done through the IMF?

Yes

What can you add or provide to the IMF's Mission?

What do you hope to gain by joining the IMF?

What educational needs do you anticipate getting from the IMF?

Appear in directories

Allow your information to appear in online directories.

Become a member