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)*
Prefix First Last
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)?*

Additional Information
For MFFLM and LFFLM candidates only: if you are applying for the Part 1 exam, should you pass it, are you planning to apply for the Part 2 that will take place next March?
For LFFLM SOM Part 2 candidates only: which exam are you applying for?
Please note that nurses may only apply for the "Adult" option.
When did you pass your Part 1 exam - or obtained DLM with Distinction?
Part 1 exam results are valid for four years.
For LFFLM (SOM) and LFFLM (GFM) candidates only: Has your Compendium of Validated Evidence (COVE) or your Case Portfolio been approved? Please also write below when. At least one of them has to have been submitted (pending approval) before you apply for the exam.
For Part 2 candidates only: would you be interested in attending a revision day for the exam you have applied for? If yes, we will contact you once revision dates have been scheduled.
Is there anything else you would like to inform the FFLM about? For example, is someone paying for your exam fee on your behalf? Please do not choose the option Direct Debit.
If your employer or friend/partner is paying for your fee please let us know so we can locate your payment easily.
Accuracy of information*
I confirm that the information provided on this application is true and accurate to the best of my knowledge. I agree to the declarations and to the privacy policy. Now that you have finished filling in your form, please click on Submit, below. If you have not yet paid for your exam fee, using the appropriate link on the Exams page, please do so now as your application is only complete once we have received your form and your payment.

Examination application form

Step 1 of 4

About You

Examination you intend to sit

Equality & Diversity

Additional Information