Telephone Interview Report
PROVIDER’S NAME: Phone Number: SPECIALTY:
DATE AVAILABLE:
GOOD MAYBE NO
DATE OF VISIT: Physician Does candidate have an MD or DO degree from a U.S. recognized medical School?
Yes
No
Has candidate completed both internship and residency in the U.S.?
Yes
No
Is the candidate board certified or board qualified for four years or less in the specialty in which candidate is applying? What type of business model is candidate seeking? Tell me a little bit about your current situation or practice. What do you enjoy doing when you are not working? What type of community do you want? Give me an idea of the top three things that are most important to you in a practice opportunity? Who else is involved in your decision to relocate? When are you expecting to start your new position?
Yes
No
Employment Multi Specialty Independent Single Specialty
What are your salary expectations? Are there any questions about this opportunity that we can answer at this time? Does candidate have ties to Texas or Wichita Falls? Are there any dietary restrictions that I should be aware of? Are you actively interviewing now? If yes, what are the locations, and when do you expect to make a decision Notes:
Do they have a Texas License:
Yes
No
Spouse & Family Information Spouse’s Name Contact phone & time to call? Occupation? And will want job? What do you and your family like to do for entertainment? What type of community and lifestyle do you want? Type of housing? Activity during visit? Spouse Questions What is important to you and your family? What type of community and lifestyle do you want? Type of housing? Activity during visit? Are there any dietary restrictions I should know about?
Yes
No
Children’s names and ages?
Age
Grade
Notes:
Special facts