Client Worksheet
TheraTeamStaffing provides quality therapy personnel to meet full-time, part-time or PRN employement needs.

Client Worksheet * Required

*Client Name

*Address

*Phone

*Email

Staffing Needs PT    OT    PTA    COTA    ST    Other

Setting OutPatient    InPatient    AcuteCare    SNF    Rehab    HomeHealth    Other

Experience Required 0-1yrs    1-5yrs    >5yrs    N/A

Special Training

Date Needed

Length of Assignment < 90days    90 days    180 days    Perm Placement

If Permanent Placement Salary: Incentives: Benefits: Title: