Apply to become a fTOE Supervisor

Your details

Name

Hospital/Trust address

An fTOE Supervisor should demonstrate suitable Echocardiography experience, as defined by an appropriate Level II TOE accreditation. Please tick the following qualifications that apply to you. ^* (required)

BSE Level 2

ASE

EACVI

Other

If you selected 'other', please provide details of you qualification.

An fTOE Supervisor should demonstrate the following experience. Please tick the following qualification that apply to you. ^* (required)

Regular practice in TOE

Active engagement with local echo governance

Other

If you answered 'other', please provide us with more information

Please provide a brief summary of your training and level of expertise in ultrasound in the critically ill. ^* (required)

Please provide supporting documentation (ie Accreditation Certificate) ^* (required)

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By completing this application, you are giving your consent for the Intensive Care Society to share the details you have provided in this form with suitable fTOE candidates. Furthermore, your details will be added to the fTOE Supervisor database to enable potential candidates to contact you directly to start their fTOE accreditation process. ^* (required)

Yes

Please confirm whether you are happy for us to promote and publish the fact that you are an fTOE supervisor ^* (required)

Yes

Please tick the box below to understand that by completing this form, you consent for the Intensive Care Society to share your details with the Association of Anaesthetists. Your data will also be shared with third party suppliers, such as our membership database company, for the purpose of the accreditation process. ^* (required)

Yes

Apply to become a fTOE Supervisor

Become a fTOE Supervisor

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