Exam Application Form

About You
By applying for any of the FFLM exams you confirm that you have read the updated Regulations of the exam you are applying for and you meet the application eligibility criteria. You confirm that you have also read the Exams page of our website and the subpages that are relevant to your exam. Note Part 1 and DLM exams are in October (application time in June). And the Part 2 exams take place in March and June (application time in November).*

I confirm I have read the updated examination regulations and meet the application eligibility criteria. I have also read the relevant sections of the exams page on the website.
Name (Do not use ALL capital letters please)*
Title First Name Last Name
Do you have any former name (before Deed Poll change, single or maiden name) or any name you are also known as?*
Former Name(s)
Email*
A personal email address, rather than a work one, is preferable. This is due to the fact that we may need to email you near the time of your exam, and we may not be able to get through to you if you are off on study leave, for example.
Enter Email Confirm Email
Address*
Street Address Address Line 2 City Postcode Country
Preferred Contact Number*
Date of Birth*
DD slash MM slash YYYY
What is your current post?*
What is your specialty?*
Who is your employer? If self employed please let us know below.*
Profession
- Doctor
- Nurse
- Paramedic
- Dentist
- Coroner
- Barrister or Solicitor
Professional Registration Body (e.g. GMC, GDC, NMC, HCPC)
What is your professional registration number (or equivalent body) number (if relevant)?*
GMC, NMC, HCPC etc
What year did you obtain full registration?*
Regarding your primary qualification, what is your degree (MD, MBBS etc)?*
When was it conferred?*
What was the issuing university?*
Where (city and country)?*

Examination Application Form

Step 1 of 4

About You

Examination you intend to sit

Equality & Diversity

Additional Information