Traveling Providers
Please tell us in which of these environments you are willing to work.  Check all that apply.
I am a
How did you hear about us? (Required Field)
Full Name
Email Address
Daily Minimum you require
State(s) licensed
Home city & state
Availability
I will become available on or about this date
Additional information on availability. 
Currently, OR WHEN I BECOME AVAILABLE, I would like to work
Primary specialty
days per week.
I could work my days per  week on any of these days:
Cell or Res Phone
By submitting this form you consent to The AJ Riggins Search Group and its affiliates contacting you at the phone numbers and/or email addresses provided.
I am currently available for locum work and could start immediately
I am currently not available for locum work, but WILL BECOME AVAILABLE as indicated below
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Solo Practice
Small Group
Large Group
Hospital
Medicaid/Medicare
Community or County  Health Centers
Correctional Care  (Prisons & Jails)
Native American Outreach Centers
Govt Contracts for 1 year
Govt Contracts for 3-6 months
I don't mind kids
I don't mind kids under 5