Shift Cancellation "*" indicates required fields Cancellation Confirmation* We would like to inform you that in the event of a cancellation within 48 hours of a scheduled assignment, a cancellation fee may be applicable. For any additional assistance, please don't hesitate to reach out to us at 910-274-2470.Name* Practice Name Office Manager Email Address Office email addressEmail Address Office Manager email addressPhone NumberPractice Phone NumberPhone NumberOffice Manager Phone NumberStart Date MM slash DD slash YYYY Start Time Hours : Minutes AM PM AM/PM End Date MM slash DD slash YYYY End Time Hours : Minutes AM PM AM/PM Position Cancellation DDS HYG DA I DA II Front Desk (FD) Other Type of Work Daily (Temporary) Full Time Temp-to-Hire Other Practice Address Street Address City State / Province / Region ZIP / Postal Code Additional commentsUntitled EmailThis field is for validation purposes and should be left unchanged.
