This information is used for discussion with candidates.
            
            
            
                Type of practice by specialty: * 
             
            
                Mandatory requirements: * 
             
            
                Desired licenses and memberships: * 
             
            
            
            
            
                Estimated Population (or catchment details) of Area Served: 
             
            
                Type of Facility (# of exam rooms, doctor’s offices, procedure room, lab): * 
             
            
                Computer System (EMR) Type: * 
             
            
                Method of Remuneration (Salary, split of gross billings, other): * 
             
            
                Estimated Gross Billings for Candidate Annually: * 
             
            
                Percentage Split (describe any changes over time): * 
             
            
                How Many Days in Office Expected Weekly: * 
             
            
                Estimated Number of Patients Seen Daily: * 
             
            
                Patient Panel Type (ages, ethnicity, underserved, addiction issues, etc): * 
             
            
            
            
                Please describe your expectations (flexible or fixed hours, weekends, etc): * 
             
            
                Any Relocation Funding/Allowance: 
             
            
                Any Retention Premium by Percentage or Flat Fee: 
             
            
                Accommodation, Transportation or Vehicle Allowance Provided: 
             
            
                Related Nearby Facilities (specialists, pharmacy, lab, physiotherapist, chiropractor): * 
             
            
                Please add any other aspects of this opening we should know requirements: