Dentist Client Form
Please Enter The Details Below
First Name
Last Name
What is the name of your practice/organisation?
What is the address of your practice?
Phone/Mobile
*
Email
*
Who is our best point of contact at your organisation?
What is their role in your organisation?
Please select
What areas of Dentistry are you looking for in a candidate?
Select all that apply
How many years experience are you looking for?
Please select
When are you hoping for someone to start?
*
Please select
Work type
*
e.g. FT, PT or Locum - select all that apply
For the right candidate, would visa sponsorship be a possibility?
Please select
What pay type do you provide?
e.g. hourly rate, percentage of billings
What is your ideal pay range or percentage range?
How many patients per day will the dentist see?
Please select
Any particular patient population at your practice? i.e. children, elderly, specific demographic
Do you provide any professional development or education?
What are the most important things about a candidate that will get you to hire them?
Is there anything else important to you?
Health Recruiters Representative Name
Submit
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