Physician Scheduling Preference Form
Submit your availability and preferences to help us optimize your work schedule.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Preferred Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Work Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Shift Type
*
Day Shift
Evening Shift
Night Shift
No Preference
Earliest Available Start Time
Hour Minutes
AM
PM
AM/PM Option
Latest Available End Time
Hour Minutes
AM
PM
AM/PM Option
Preferred Work Location(s)
Main Hospital
Satellite Clinic
Telemedicine
Other
Maximum Consecutive Shifts Preferred
Are you willing to work weekends and holidays?
*
Yes, both weekends and holidays
Weekends only
Holidays only
Neither
Additional Comments or Scheduling Requests
Submit Preferences
Should be Empty: