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Request Help
Use this form to request an employee placement through Dental Express Staffing.
Practice Name
Location
Contact Person
Phone Number
After Hours Phone Number
Contact # for unexpected schedule changes
Email
Date(s) Needed
Patient Hours
Substitute will arrive 30 minutes earlier
Employee Position
RDH
DA
Admin
Notes
Updates
Only if there have been changes since last DES request
Current Software Being Used
Only if there have been changes since last DES request
Current Dentist(s) Employed
Only if there have been changes since last DES request
Willing to pay mileage if necessary?
Yes
No
Submit
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Cancel Date(s)