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This form should be completed approximately 3 months prior to your anticipated leave date. If the absence is unplanned please complete this form at the earliest opportunity.

This form is to be completed by the trainee alongside the Educational Supervisor/Training Programme Director/College Tutor - as most appropriate for the individual trainee and specialty.

Further information regarding the Supported Return to Training Programme (SuppoRTT) within the West Midlands can be accessed here.

*Please note* when you have completed the questions, there is an option to download a copy of your responses.  If you will need to refer to these at a later date, we recommend that you do download these as they will not be available afterwards

Please enter a whole number (integer).

Your answer should be no more than 9 characters long.