International MedLink, Inc. (IML)

Hospital Information Request Form For Facilities Only.
Our goal is to assist you in meeting your staffing needs for your hospital(s) and healthcare facilities. Please fill out and submit this short form to obtain the latest information on available IML RNs. Your personal IML Account Manager will contact you within 24 hours (Monday - Friday). If you have any questions and wish to reach us by phone, please visit our contact page.

* Indicates Required Fields

	* Name:
	* Facility name:
	Address 1:
	Address 2:
	City:
	State:
	Zip code:
	* Email address:
	* Phone:
	Fax:

	Unit name:
	Unit description:
	Positions needed:
	Number of positions needed:
	Shift:	8 hr10 hr12 hr DaysEveningsNights

	Comments:

Chicago - Midwestern U.S. Angelo Garoufalis 200 E. Deleware Pl, Apt 5C Chicago, IL 60611 Telephone: 312.664.2232	Evans M. Clements, III Telephone: 615.385.7236 5380 Hillsboro Rd. Nashville, Tennessee 37215 U.S.A.