Information form - Standardized patient
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First name and last name *
Your answer
Email adress *
Your answer
Phone number *
Your answer
Date of birth
MM
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DD
/
YYYY
Do you have any experience as an actor ?Wich one ? *
Your answer
Do you have any experience in teaching ? Wich one ? *
Your answer
Could you play a person with mental health issues (for example : rage, schizophrenia) ? *
Required
Could you play a senior with cognitive disorder (for example : senility, mobility) ? *
Required
Your availability *
Others availabilities
Your answer
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