Client Intake Form Client Name: Is this a confidential search? YesNo Is there anyone at the practice who is NOT aware of this searchand should not be? If so, who: YesNo What specialty? (General, Prosthodontist, Pediatrics, etc) Job Title: Practice Name: Practice Location: Compensation: Email Address: This opportunity includes: (Sign on bonus, relocation assistance, benefits, non-clinical support, etc) Qualifications needed: (New grads accepted, etc) What is the reason for the search? Anything else you want to tell us about the job or the interview process?