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Facility Onboarding
Staff request

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About Us
Prestige
Community
Contact Us
Facility Onboarding
Staff request

Facility Onboarding Form – Prestige Medical Staffing

Purpose: To collect essential information from new partner facilities for staffing coordination,
credentialing, and compliance.

Facility Information

Staff request

Facility name

Type of Facility:

Nursing Home Group Home Assisted Living Clinic Other

Address

City/State/ZIP:

Primary Contact Name

Title/Role

Phone Number

Email Address:

Staffing Needs

Requested Start Date

Staffing Type Needed

RN LPN CAN NP Sitter

Shift Coverage

Day Evening Night Weekend Holiday

Frequency

PRN Short-Term Long-Term Ongoing

Credentialing & Compliance

PhoneFacility License Number Number

Billing Contact (if different)

Preferred Method of Documentation Delivery

Email Fax Secure Portal

Agreements & Acknowledgments

I acknowledge that all staff provided will meet state credentialing requirements. I agree to provide timely feedback and shift confirmations. I understand that Prestige Medical Staffing maintains HIPAA compliance and liability coverage.

Signature

First NamAuthorized Representative Name

Date

Prestige Medical Staffing

Guardians of Health, connecting exceptional healthcare
talent with facilities that need them most.

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