Contract Supply Clients


*Practice Name:
Describe your Practice 
*Specialties: (Select all that apply)
Anesthesiology Oncology
Cardiology Ophthalmology
Dermatology Orthopedics
Endocrinology Otolaryngology
ENT Pain Management
Family Medicine Pediatrics
Gastroenterology Physiatry
General Surgery Psychiatry
Geriatrics Pulmonology
Gynecology Radiology
Hematology Rheumatology
Internal Medicine Sports Medicine
Neurology Surgery - Other
Neurosurgery Urology
Obstetrics Other  
*City:
*State:
*Number of Doctors in Group:  
 
Utilize Physician Extenders:
  Yes    No
Number of Years in Business:
 
Payer Mix: *Medicare %     
*
Commercial %
*Use a Hospitalist: Yes    No     
Care for own Inpatients: Yes    No  
*Call Schedule:
*Practice has the following Ancillaries in house: (Check all that apply.)
  Echocardiography   
GXT
Lab
Neurodiagnostics (NCV / EMG)
Nuclear Stress Testing
Ultrasound
Vascular Studies
X-Ray
Other 
*Electronic Medical Record (EMR):
  Yes    No   If yes, Brand:
Describe the Opportunity:  
Availability Requirement:
Health Insurance:
Malpractice Insurance:
Relocation:
School Loan Assistance:
Vacation:
Continuing Medical Education:
Salary Range:
Bonus Plan:  
Requirements  
*Boards:
*Years of Experience:
*Acceptable Specialties:  (Select all that apply)
Anesthesiology Oncology
Cardiology Ophthalmology
Dermatology Orthopedics
Endocrinology Otolaryngology
ENT Pain Management
Family Medicine Pediatrics
Gastroenterology Physiatry
Geriatrics Psychiatry
Gynecology Pulmonology
Hematology Radiology
Internal Medicine Rheumatology
Neurology Sports Medicine
Neurosurgery Urology
Obstetrics Other  
Languages Desired: (Check all that apply.)
English Basic English Fluent
Spanish Basic Spanish Fluent
Italian Basic Italian Fluent
French Basic French Fluent
Other  
Describe your geographic area: (Check all that apply.)
Convenient Airport Fishing
Great Nightlife Great restaurants
Great Shopping Hiking
Hunting Professional Sports
Snow Skiing Theatre
Water Sports Other
 
Schools Available:
Small Public
Large Public
Private
Private Christian
Other
You may provide additional information for candidates or copy/paste a job description:  
    
Contact Information  
*Contact Name:
*Phone:
Fax:
*Email:
Mailing Address  
*Street Address:
*City:
*State:
*Zip Code:
Send response via: Email
Mail
Fax
Telephone
If response by Mail, Email or Fax, please include:
Curriculum Vitae
References
Photograph