Locum Tenens Physician Inquiry form for Med-Link Staffing

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Physicians please use the following form to contact us with your information and questions. We look forward to speaking with you.

First Name:

Middle Initial:

Last Name:

Title: MDDO

Specialty:

Address:

City:

State:

Zip:

Email:

Home Phone:

Work Phone:

Pager:

Fax:

Cell/Mobile:

Best Time to Call:

Morning or Afternoon: ampm

State Licenses:

Locum Tenens? YesNo

Perm Placement? YesNo

Please check Yes when all of your info has been entered. * Yes

Please fax your CV to us at 877.269.6425

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