Physician Recruitment

Contact Information

First Name

Last Name

Date of Birth (this information is used to book travel arrangements.)

Address

City

State

Zip code

Phone Number

Preferred method of communication? (We will use this as the primary method to communicate with you as we setup your site visit, itinerary and details.)

Text
Email
Phone

Travel Plan

Do you plan to travel alone?

If no, please list name(s), DOB and gender for any individuals traveling with you. (Note: We ask for this information for potential flights or car rental purposes. *If you are traveling with small children, please bring your own personal car seat and/or booster seat, pack-n-play, if needed.)

We are happy to provide a separate itinerary for individuals traveling with you. This will include a list of activities/restaurants/community activities they may enjoy while you attend onsite meetings throughout your visit. Would you like us to prepare this?

If yes, what type of activities do they enjoy? Please share any interests that may help us prepare an agenda.

Which airport do you prefer to depart from?

On-Site Visit

Do you have any food allergies or restrictions?

Our community realtors provide a complimentary community tour as part of your visit. Are you interested in a community tour?

Incoming Physician Real Estate Questionnaire

In addition to the physician, is there an additional contact person you would like our realtor to communicate with during and after your site visit? Email and phone numbers for this person will be used to make initial contact, forward materials and finalize any tour plans.

Alternate Contact

Relationship to Physician

Alternate Email

Primary Phone Number

Family Demographics and Interests:

Any special accommodations? (Yes/No) If yes, please list.

Any language barriers to be aware of?

If yes, please specify

Are you familiar with Central Illinois?

If yes, please explain

Outside interests for family (i.e. sports, reading, cooking, gardening etc.)

Tour Specifics:

In addition to the tour, do you wish to see potential homes as well?

If yes, please list any specific needs

Do you wish to tour schools and/or daycare options?

If yes, please list any specific information about needs that might be helpful.