Clinical Team Scheduling Change Request
This form is the only accepted method for requesting a scheduling change or use of PTO. Submitting a request does not guarantee that your request will be granted. You will receive confirmation from our scheduler as soon as possible. Thank you!
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Full Name *
Email address *
Date of Shift (or Shifts) for requested change. Please also note which shift or shifts (day, evening, night). *
Reason for request *
Have you attempted to find your own coverage?
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If you have found your own coverage, who is willing to cover your shift? Please note if a switch is occurring and the date of the switch.
Are you requesting to use PTO?
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Do you have a different kind of request for our scheduler? Please note below.
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