Tuesday, September 07, 2010
 Physicians Seeking Jobs

Thank you for contacting Summit Placement Service. We are very interested in serving you with excellence. Please take about 30 seconds to answer the questions below. One of our representatives will contact you promptly. Thank you and we look forward to assisting you.

Once you complete the form. Please click "SUBMIT" at the bottom of the page.


 Physician Questionnaire

What is your name?
Please provide the best time and phone number at which you can be reached:
What is the best email address to correspond with you?
Please describe your current practice situation, including current income, workload, call schedule, and vacation schedule:
Please describe the type of practice situation for which you are looking, including group size, desired first year income, desired call schedule, and desired vacation/benefits schedule:
What is your main geographic preference? Please include current city size, desired city size, current region, and desired region.
What are the three key factors that need to be in place for you to be interested in a practice?
Are you B/C or B/E? What year?
What is/are your reason(s) for looking for a new practice?
In what state(s) are you licensed?
Please describe your family status, including any applicable information on your spouse and children:
What is your date of availability?
In what types of cases/modalities do you specialize?
Are you a partner?

On a scale of 1 to 10, with 1 being "remote" and 10 being "completely certain," what is the likelihood of you relocating if you find a good opportunity?
Attach your CV
Submit 

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