The contents of this form will be shared with the DIO and Director of GME at UCLA only using a forms interface that we are unable to trace. Identifying information including IP addresses and location information CANNOT be traced back to you. 

The GME office takes every precaution to ensure your anonymity is preserved.

You may report instances of experienced mistreatment on the Mistreatment Incident Reporting Form (MIRF).

In addition to your contact with the DIO, the DGSOM and UCLA Health Ombuds Office is available to meet and keep you concerns in confidence: Ombuds@conet.ucla.edu