Contact Information


If you are a new client or have worked with RMG in the past, please fill out the form below and submit to make our staff of professionals aware of your coverage needs. One of our representatives will follow up with you immediatly to discuss your options for filling those available dates...


Required

Contact:
Title:
Group:
Facility:
Address:
City:
State: Country:
Postal Code:
Phone:
Fax:
email:
Position: # Needed:
Dates Needed Start: End:

Scheduled Work Week:
Type of Call: Beeper:   In-House:

Weekday Call Schedule:

Weekend Call Schedule:

Overtime:
Board Certified: Yes No
Board Eligible: Yes No
ACLS: Yes No
AANA (If applicable) Yes No
J-1 Visa Yes No
Fellowship Required ?
Types of Cases:
How did you hear about us?

Notes / Other / Description:

   

 



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