Resident Physician Confidential Concern Reporting Form

Resident e-mail address cannot be tracked using this site. All reporting is anonymous and confidential.

The resident/fellow confidential report form has been established for all residents and fellows to use to report any concerns about their training program. Reporting of concerns through the form are anonymous. However, if you would like to be contacted about your comment, please feel free to provide your name, email and/or contact number and someone from the GME office will contact you soon.

If this is a medical emergency, please call 911. If you are in crisis, please call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

Please report discrimination in any form (including age, race, gender) or sexual misconduct concerns directly to the UTRGV Office of Title IX & Equal Opportunity (OTIXEO) office using the OTIXEO Report It Form. The OTIXEO Report It Form allows for anonymous reporting. The GME Confidential Reporting Form is NOT the appropriate tool for reports of sexual misconduct or discrimination.

If you have any questions about what OTIXEO or OAVP (Office for Advocacy & Violence Prevention) offers, we encourage you to visit their websites, respectively, www.utrgv.edu/otixeo and www.utrgv.edu/oavp.

Resident Information

I verify that I am a UTRGV Resident (Required) (Special instructions) Yes UTRGV Resident

Program (Required) Rotation (optional) Complaint Description (Required)

Please indicate if you would like to be contacted (Required) (Your comment will remain confidential regardless of whether you prefer to remain anonymous or be contacted regarding your concern.) Yes,
No, I prefer to remain anonymous.

Contact Info Name Phone Number UTRGV E-mail

Graduate Medical Education UTRGV School of Medicine

Resident Physician Confidential Concern Reporting Form