POSITION OF THE PERSON YOU TALKED TO
*
Please Select
DIRECTOR OF NURSING (IDEAL)
STAFFING COORDINATOR
EXECUTIVE DIRECTOR
OWNER
RECEPTIONIST (NOT IDEAL)
OTHER (NOT IDEAL)
CONTACTS NAME
*
First Name
Last Name
FACILITYS NAME
*
CONTACTS EMAIL
*
example@example.com
CONTACTS DIRECT NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
WHAT STATE IS CLIENT IN
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
CLIENT NOTES
IS THERE A SPECIFIC NEED THEY ARE LOOKING FOR / SHIFT
Please Select
CNA / MORNINGS
CNA / EVENINGS
LPN / MORNINGS
LPN / EVENINGS
RN / MORNINGS
RN / EVENINGS
OTHER / MORNINGS
OTHER / EVENINGS
MIXED / MORNINGS
MIXED EVENINGS
MIXED
RELEVANT NOTES (NOTES GO DIRECTLY TO CLIENT)
Like extensions, selling points, exact needs, kick back, etc.
IS THIS A FOLLOW UP LEAD
YES
NO
SCHEDULE YOUR FOLLOW UP CALL
SCHEDUAL YOUR FOLLOW UP CALL
CALLER
Please Select
TYJ
MGD
VSM
WHICH CLIENT ACCOUNT IS THIS FOLLOW UP FOR?
DO NOT LEAVE THIS BLANK
RATE THIS LEAD
1
2
3
4
5
Rate this lead based on contacts tone and willingness to respond / act, 1 Star being not really interested, 5 stars being ready to sign - up tomorrow.
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