{"id":17685,"date":"2018-08-07T19:15:37","date_gmt":"2018-08-07T19:15:37","guid":{"rendered":"http:\/\/workforcetransformations.com\/?page_id=17685"},"modified":"2018-08-07T19:16:11","modified_gmt":"2018-08-07T19:16:11","slug":"clientregistration","status":"publish","type":"page","link":"https:\/\/workforcetransformations.com\/index.php\/clientregistration\/","title":{"rendered":"Client Registration"},"content":{"rendered":"<p>[vc_row][vc_column][vc_column_text]\u00a0 [\/vc_column_text]<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-17684\"><form id=\"wpforms-form-17684\" class=\"wpforms-validate wpforms-form\" data-formid=\"17684\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/17685#wpforms-17684\"><div class=\"wpforms-field-container\"><div id=\"wpforms-17684-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_2\">Health System Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17684-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/div><div id=\"wpforms-17684-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_10\">Facility Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17684-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><div id=\"wpforms-17684-field_11-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_11\">Facility Type <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][11]\" id=\"wpforms-17684-field_11\" class=\"wpforms-field-medium wpforms-field-required\"  required ><option value=\"Select One\" >Select One<\/option><option value=\"Ambulatory Care\" >Ambulatory Care<\/option><option value=\"Colleges and Universities\" >Colleges and Universities<\/option><option value=\"Dentistry\" >Dentistry<\/option><option value=\"First Responders\" >First Responders<\/option><option value=\"Freestanding Healthcare Lab\" >Freestanding Healthcare Lab<\/option><option value=\"Healthcare Business-Other\" >Healthcare Business-Other<\/option><option value=\"Home Care\" >Home Care<\/option><option value=\"Hospital\" >Hospital<\/option><option value=\"Imaging Centers\" >Imaging Centers<\/option><option value=\"Long Term Care Facilities\" >Long Term Care Facilities<\/option><option value=\"Pharmacy\" >Pharmacy<\/option><option value=\"Physicians\" >Physicians<\/option><option value=\"Schools\" >Schools<\/option><option value=\"Surgery Centers\" >Surgery Centers<\/option><option value=\"Veterinary\" >Veterinary<\/option><option value=\"\" ><\/option><\/select><\/div><div id=\"wpforms-17684-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_12\">Facility Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17684-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-17684-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_13\">Annual Estimated Contract Labor Spend<\/label><input type=\"text\" id=\"wpforms-17684-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-17684-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_15\">Executive Sponsor - Name, Title, Email &amp; Phone Number<\/label><textarea id=\"wpforms-17684-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/textarea><\/div><div id=\"wpforms-17684-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_16\">Daily Contact - Name, Title, Email &amp; Phone Number<\/label><textarea id=\"wpforms-17684-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" ><\/textarea><\/div><div id=\"wpforms-17684-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_19\">Offering Options (Select All That Apply)<\/label><ul id=\"wpforms-17684-field_19\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_4\" name=\"wpforms[fields][19][]\" value=\"Nursing\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_4\">Nursing<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_5\" name=\"wpforms[fields][19][]\" value=\"Allied\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_5\">Allied<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_6\" name=\"wpforms[fields][19][]\" value=\"Non Clinical\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_6\">Non Clinical<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_7\" name=\"wpforms[fields][19][]\" value=\"Locum Tenens\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_7\">Locum Tenens<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_8\" name=\"wpforms[fields][19][]\" value=\"Interim Management\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_8\">Interim Management<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_19_9\" name=\"wpforms[fields][19][]\" value=\"Perm Placement\/RPO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_19_9\">Perm Placement\/RPO<\/label><\/li><\/ul><\/div><div id=\"wpforms-17684-field_20-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_20\">Implementation Timeline Request<\/label><select name=\"wpforms[fields][20]\" id=\"wpforms-17684-field_20\" class=\"wpforms-field-medium\"  ><option value=\"Select One\" >Select One<\/option><option value=\"ASAP\" >ASAP<\/option><option value=\"45 Day Express\" >45 Day Express<\/option><option value=\"90 Day Traditional\" >90 Day Traditional<\/option><\/select><\/div><div id=\"wpforms-17684-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_21\">Consulting Service (Please note that first 100 hours are free with MSP contract)<\/label><ul id=\"wpforms-17684-field_21\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_21_1\" name=\"wpforms[fields][21][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_21_2\" name=\"wpforms[fields][21][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_21_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-17684-field_26-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_26\">Open needs today?<\/label><ul id=\"wpforms-17684-field_26\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_26_1\" name=\"wpforms[fields][26][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-17684-field_26_2\" name=\"wpforms[fields][26][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17684-field_26_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-17684-field_23-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_23\">If &quot;Yes&quot; - Please provide details.<\/label><textarea id=\"wpforms-17684-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/textarea><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-field_hp\" class=\"wpforms-field-label\">Email<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-field_hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"17684\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"5\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-17684\" value=\"wpforms-submit\" data-alt-text=\"Sending...\">Submit<\/button><\/div><\/form><\/div>[\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text]\u00a0 [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"footnotes":""},"class_list":["post-17685","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/pages\/17685","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/comments?post=17685"}],"version-history":[{"count":2,"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/pages\/17685\/revisions"}],"predecessor-version":[{"id":17687,"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/pages\/17685\/revisions\/17687"}],"wp:attachment":[{"href":"https:\/\/workforcetransformations.com\/index.php\/wp-json\/wp\/v2\/media?parent=17685"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}