Provider intake

Start a locum-ready profile.

Share your specialty, availability, preferred shift lengths, license states, document readiness, and assignment preferences.

What happens next

A Locum Friends coordinator reviews the intake, clarifies missing details, and moves the request into the right hospital, vendor, provider, credentialing, schedule, or time-pay workflow.

Who handles this next?

Primary handoff: Provider profile → Locum Friends matching desk → appropriate hospital or vendor workflow.
Use your own best contact details so assignment, credentialing, and document questions reach you directly.
If a staffing company is submitting you, ask them to use Candidate Packet instead.

After you send

Confirmation goes to you directly so availability, credentialing, assignment, and document questions do not route through the wrong party.
If a staffing company is managing the submission, ask them to use Candidate Packet instead of entering vendor-managed details here.

ReceiveClarifyRouteTrack

Hospital Vendor Candidate Provider General

Website

Name Who should the Locum Friends team contact about this request? Email Use the inbox where status updates and follow-up questions should go. Organization Facility, practice, staffing company, or organization name. Phone Optional, but helpful for urgent coverage or credentialing questions. Provider type Examples: MD, DO, NP, PA, CRNA, RN, allied health. Specialty Primary specialty you want Locum Friends to match first. Subspecialty Optional focus area, fellowship, or procedure niche. NPI Optional for intake; helps speed profile matching later. License states List active licenses and any states in process. Availability Earliest start date, preferred blocks, or blackout dates. Shift preferences Preferred shift length, call limits, travel radius, or schedule pattern. Credential document status Examples: documents ready, CV updated, references pending. Pay or contract preferences Optional rate, contract, travel, or payment preferences. Notes Add decision deadlines, blockers, or the fastest next step for the team.

Please share only the details needed to route your request. Do not include SSNs, dates of birth, patient information, or other sensitive personal health information in this public form.

Ready to send?