HiddenNext Steps: Install the Survey Add-OnThis form requires the Gravity Forms Survey Add-On. Important: Delete this tip before you publish the form.Facility Type:(Required)Long Term Care/Skilled Nursing CenterHospital/Acute Care FacilityOutpatient ClinicDoctors OfficeOther (Please specify below)Please specify your facility type: Do you utilize healthcare staffing agencies for staffing needs?(Required) Yes No In what capacity does your facility utilize agency staffing? Permanent Hire Short Term Full Time Contracts PRN/Per-Diem Please select all professions currently provided by healthcare staffing agencies: Registered Nurse (RN) Licensed Practical Nurse (LPN) Nursing Assistant (CNA/STNA) Nurse Practitioner (NP) Other Please list the current average hourly bill rate for staffing services:Registered Nurse (RN)Licensed Practical Nurse (LPN)Nursing Assistant (CNA/STNA)Nurse Practitioner (NP)Other (Please Specify Profession) Please list your desired hourly bill rate for staffing services:Registered Nurse (RN)Licensed Practical Nurse (LPN)Nursing Assistant (CNA/STNA)Nurse Practitioner (NP)Other (Please Specify Profession) Δ 614-389-2571 5890 Venture Drive Dublin, Ohio 43017
