Locum Coverage Request

Locum Coverage Request

Need a vacation? We will try our best to find a locum for you! Please share your contact information and dates of required coverage below.

Question Title

* 1. Please share your contact information below:

Name

Clinic

City/Town

Email Address

Phone Number

Question Title

* 2. Please share the dates when you require coverage?

Question Title

* 3. Are you able to provide accommodation and or a vehicle, or other perks? Please describe:

Question Title

* 4. Please provide specifics on coverage needed (i.e. Hospital, ER, extended care, etc).

Question Title

* 5. What type of EMR is in place in your practice?

Question Title

* 6. Thank you for your request. Please enter any additional information you wish to share here: