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Ayurveda Intern Information Form

 

Required for Clinical Supervision Program

    Clinic Intern Information

    Please answer the following questions

    Attach a full color high resolution headshot. Ideal file size: 400KB - 1MB.


    The Clinical Supervision Program is run as a collaboration between Sevanti Institute and Sevanti Wellness. Bookings of the Clinic Interns are made on the Sevanti Practice website, which is the group practice wing of Sevanti Wellness. We rely on the information that you provide in this application to assist you in the transition to Clinic Intern status and to create the needed technical platform tools you will need as a Clinic Intern at the SP Ayurveda Student Clinic. Your practice availability information will assist us in setting up your online booking account on the Acuity platform. Your photo will be posted on the SP Ayurveda Student Clinic webpage.

    I attest that the information contained in this application to Sevanti Institute is complete, accurate and true.

    Signature and Date

    Date

    April 1st, 2025