*Practice Name:
Describe your Practice
*Specialties: (Select all that apply) Anesthesiology Oncology Cardiology Ophthalmology Dermatology Orthopedics Endocrinology Otolaryngology ENT Pain Management Family Medicine Pediatrics Gastroenterology Physiatry General Surgery Psychiatry Geriatrics Pulmonology Gynecology Radiology Hematology Rheumatology Internal Medicine Sports Medicine Neurology Surgery - Other Neurosurgery Urology Obstetrics Other
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
*Number of Doctors in Group:
	Select One 1 - 3 4 - 6 7 - 9 10+
Utilize Physician Extenders:
	Yes    No
Number of Years in Business:
	1 - 3 4 - 6 Select One 7 - 9 10 - 15 15 - 20 20+
Payer Mix:	*Medicare %      *Commercial %
*Use a Hospitalist:	Yes    No
Care for own Inpatients:	Yes    No
*Call Schedule:	Weekly Monthly Other None
*Practice has the following Ancillaries in house: (Check all that apply.)
	Echocardiography    GXT Lab Neurodiagnostics (NCV / EMG) Nuclear Stress Testing Ultrasound Vascular Studies X-Ray Other
*Electronic Medical Record (EMR):
	Yes    No   If yes, Brand:
Describe the Opportunity:
Availability Requirement:	Select One 3 - 6 Months 6+ Months Flexible/Negotiable
Health Insurance:	Select One Individual covered at practice expense Family covered at practice expense Negotiable None
Malpractice Insurance:	Select One Covered at practice expense Subsidized Negotiable
Relocation:	Select One Fully Covered Subsidized Negotiable None
School Loan Assistance:	Select One Yes No Negotiable
Vacation:	Select One One week Two weeks Three weeks Four weeks Five weeks or above
Continuing Medical Education:	Select One One week Two weeks Three weeks Four weeks Five weeks or above
Salary Range:	Select One $100,000 - $149,000 $150,000 - $199,000 $200,000 - $249,000 $250,000 - $299,000 $300,000 - $349,000 $350,000 - $399,000 $400,000 - $449,000 $450,000 - $499,000 $500,000 or greater
Bonus Plan:
Requirements
*Boards:	Select One Board Certified Board Eligible None
*Years of Experience:	Select One 0 - 3 4 - 7 8+
*Acceptable Specialties:  (Select all that apply)
Anesthesiology Oncology Cardiology Ophthalmology Dermatology Orthopedics Endocrinology Otolaryngology ENT Pain Management Family Medicine Pediatrics Gastroenterology Physiatry Geriatrics Psychiatry Gynecology Pulmonology Hematology Radiology Internal Medicine Rheumatology Neurology Sports Medicine Neurosurgery Urology Obstetrics Other
Languages Desired: (Check all that apply.) English Basic English Fluent Spanish Basic Spanish Fluent Italian Basic Italian Fluent French Basic French Fluent Other
Describe your geographic area: (Check all that apply.) Convenient Airport Fishing Great Nightlife Great restaurants Great Shopping Hiking Hunting Professional Sports Snow Skiing Theatre Water Sports Other
Schools Available:	Small Public Large Public Private Private Christian Other
You may provide additional information for candidates or copy/paste a job description:
Contact Information
*Contact Name:
*Phone:
Fax:
*Email:
Mailing Address
*Street Address:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
*Zip Code:
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