{"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":"<div class=\"wpb-content-wrapper\" id=\"wpb-content-root\"><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\" data-token=\"384f9565e7e504fe92bb9a7dd3499a1d\" data-token-time=\"1792450284\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-17684-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"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-type=\"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-type=\"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 id=\"wpforms-17684-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"Select One\"  class=\"choice-20 depth-1\"  >Select One<\/option><option value=\"Ambulatory Care\"  class=\"choice-4 depth-1\"  >Ambulatory Care<\/option><option value=\"Colleges and Universities\"  class=\"choice-5 depth-1\"  >Colleges and Universities<\/option><option value=\"Dentistry\"  class=\"choice-6 depth-1\"  >Dentistry<\/option><option value=\"First Responders\"  class=\"choice-7 depth-1\"  >First Responders<\/option><option value=\"Freestanding Healthcare Lab\"  class=\"choice-8 depth-1\"  >Freestanding Healthcare Lab<\/option><option value=\"Healthcare Business-Other\"  class=\"choice-9 depth-1\"  >Healthcare Business-Other<\/option><option value=\"Home Care\"  class=\"choice-10 depth-1\"  >Home Care<\/option><option value=\"Hospital\"  class=\"choice-11 depth-1\"  >Hospital<\/option><option value=\"Imaging Centers\"  class=\"choice-12 depth-1\"  >Imaging Centers<\/option><option value=\"Long Term Care Facilities\"  class=\"choice-13 depth-1\"  >Long Term Care Facilities<\/option><option value=\"Pharmacy\"  class=\"choice-14 depth-1\"  >Pharmacy<\/option><option value=\"Physicians\"  class=\"choice-15 depth-1\"  >Physicians<\/option><option value=\"Schools\"  class=\"choice-16 depth-1\"  >Schools<\/option><option value=\"Surgery Centers\"  class=\"choice-17 depth-1\"  >Surgery Centers<\/option><option value=\"Veterinary\"  class=\"choice-18 depth-1\"  >Veterinary<\/option><option value=\"Choice 19\"  class=\"choice-19 depth-1\"  >Choice 19<\/option><\/select><\/div><div id=\"wpforms-17684-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"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-type=\"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-type=\"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-type=\"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-type=\"checkbox\" data-field-id=\"19\"><label class=\"wpforms-field-label\">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-type=\"select\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_20\">Implementation Timeline Request<\/label><select id=\"wpforms-17684-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\"><option value=\"Select One\"  class=\"choice-4 depth-1\"  >Select One<\/option><option value=\"ASAP\"  class=\"choice-1 depth-1\"  >ASAP<\/option><option value=\"45 Day Express\"  class=\"choice-2 depth-1\"  >45 Day Express<\/option><option value=\"90 Day Traditional\"  class=\"choice-3 depth-1\"  >90 Day Traditional<\/option><\/select><\/div><div id=\"wpforms-17684-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"21\"><label class=\"wpforms-field-label\">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-type=\"checkbox\" data-field-id=\"26\"><label class=\"wpforms-field-label\">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-type=\"textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-17684-field_23\">If &quot;Yes&quot; 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