Nursing Questionnaire

Name(Required)

First Last

Cell Phone(Required)

Email(Required)

Enter Email Confirm Email

City(Required)

State(Required)

Zip(Required)

What do you love about nursing?(Required)

What made you decide to become a nurse?(Required)

How long have you been a Registered Nurse?(Required)

How long have you been in home infusion?(Required)

What Specialty Infusion Companies are you familiar with?(Required)

What area of Nursing have you worked in? Home Health?(Required)

How are your IV skills? Do you do PICC Dressing Changes? Can you access Ports?(Required)

Have you ever given Specialty Medications (e.g. IVIG? Biologics? Antibiotics in the Home?)(Required)

Are you currently working? Full-time? Part-time? Do you have weekend or evening availability?(Required)

Do you need benefits? Health Insurance?(Required)

Have you ever been an Independent Contractor? Do you understand what that means?(Required)

Are you familiar with Ambulatory Infusion Pump? Curlin pump? CADD? Sapphire? Freedom 60?(Required)

Do you think you would need to go with another nurse to get started?(Required)

How are you with technology?(Required)

How do you prefer to communicate? Text? Email?(Required)

Do you hold any specialty certifications?(Required)

Are you OK driving distances? How far?(Required)

Do you have weekend or evening availability?(Required)