Form Submission

Assessment Sign Up

Thank you for conducting an assessment with St. John's Health Network!

St. John's Health Network provides you with the valuable service of assessing the cost of nurse staffing shortages on your organization, whether shortages are occurring now or projected into the future. Additionally, we will calculate the projected net savings associated with solving your staffing problem with an international nurse program, including savings that result from reduced overtime, decreased use of agency and travel nurses and increased revenues that result from ending staffing-related diversions.

To sign up for your assessment, please complete the following information. When complete, select the button at the bottom of the page to submit your information. Soon after submission of this form, you will receive a call from one of our team members to gather additional information and confirm a time to conduct an assessment.

First Name:
Last Name:
Title:
Organization:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Assessment Date & Time:
ASHHRA Member:
NAHCR Member:

* The "Assessment Date & Time" is a date and time that works best for you to conduct this assessment. A 90-minute meeting will be required. (For example, specify the date and time as "9/1/2006 1:30pm Eastern Time")