Hospital Healthcare Staffing Request

Thank you for your interest in Fastaff. Our goal is to help you with your healthcare staffing needs in a timely manner.  Please tell us a little bit about your facility's current staffing needs below so that we can assist you. We will contact you within 24 hours, Monday - Friday.

Facility Information

First Name: *

Last Name: *

Title:

Facility Name: *

Contact Information

Phone: *

Fax Number:

Email Address:

How do you prefer to be contacted:

Phone

Email

Additional Information

How did you find out about us: * - Select -FASTAFF Web SiteWeb AdvertisementSearch EngineMagazineDirect MailNewspaperTrade ShowMobile RecruitmentPersonal ReferralOther Source

Please Specify:

Is your facility part of healthcare network:

Yes

No

Which Network?:

When do you anticipate needing help with your staffing requirements: - None -Immediately1-2 weeks2-4 weeks6-8 weeksNot sureOther

Approximately how many travel nurses will you need: * - Select -1-1011-2021-3031-5051-100100+

Is your facility undergoing a special project(i.e., computer conversion, expansion, etc.):

Yes

No

If yes, when: - None -Immediately1-2 weeks2-4 weeks6-8 weeksNot sureOther

What type: - None -Computer ConversionExpansionOther

What areas of expertise are you looking for?:

Word verification: * (verify using audio)

Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.