Application Form for Post Doctoral Fellowship Program in Movement Disorders

Name of the Institute *

Course Director's Name for the Movement Disorders Fellowship Program *

Contact Person *

Name *

Email ID *

Phone Number *

Qualifying criteria for fellows *

Number of Movement Disorders trained faculty *

Faculty 1 *

Name of faculty *

Degree of the faculty *

Fellowship duration of the faculty (if fellowship in Movement Disorders done) *

Institute from where fellowship obtained (if fellowship in Movement Disorders done) *

Post fellowship experience (if fellowship in Movement Disorders done) *

Present Designation of the faculty *

if not fellowship trained, number of years of experience and focused work in Movement Disorders *

Add faculty

Proposed duration of the Program*

Full-fledged Neurology Department*

Number of weekly Movement Disorder Clinic *

Number of BOTOX Movement Disorder Clinic per year *

Number of Deep Brain Stimulation (DBS) surgery per year *

Will the fellow get the opportunity to be involved in DBS surgery for Movement Disorders*

Will the fellow be exposed to Infusion therapy (like Apomorphine)*

Number of Movement Disorders Video Sessions per month*

Number of Monthly Bedside Case discussions*

Mention in brief about the opportunities for the fellows to be part of Movement Disorders Research Projects*

Mention in brief about the opportunities for the fellows to be part of the Movement Disorders Clinical Trials*

Please mention whether the fellows will be trained in the following: *

Select Training

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Outpatient Training Inpatient Training Movement Disorders Emergencies Video recordings and successive presentation of various Movement Disorders Training in genetics for various Movement Disorders Infusion therapy Exposure to clinical trials

Submit

Movement Disorders Society of India

Leading the Journey Towards Better Mobility, Knowledge and Support for All Impacted by Movement Disorders

Application Form for Post Doctoral Fellowship Program in Movement Disorders