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Global Connect HEALTH, Inc.
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Intake form
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Name
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Email address
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What type of healthcare professional are you?
Please select at least one option.
Nurse
Physician
Therapist
Allied Health
Healthcare Administrator
What type of staffing request do you have?
Select
Temporary Staffing
Permanent Placement
Travel Assignments
Per Diem Staffing
What is your preferred specialty?
Please select at least one option.
Emergency Medicine
Pediatrics
Critical Care
Surgery
Physical Therapy
Occupational Therapy
Speech Language Pathology
What is your expected contract length?
Select
Less than 1 month
1-3 months
3-6 months
6-12 months
More than 12 months
What is your location preference?
What are your availability hours?
Additional questions or comments
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