top of page

Independent Contracted Healthcare Workers
Looking for Contract work instead of the Traditional?
Are you ready for a change in your healthcare career? If you're a healthcare worker exploring contract work, seeking to try a new environment, or feeling burnt out, we want to hear from you! Take a moment to fill out our questionnaire and discover your next adventure—it could be just around the corner!

The following questionnaire is designed for healthcare workers looking to provide contracted healthcare services.  Its purpose is to gather valuable insights about your professional experiences, practice standards, challenges encountered, and the quality of care delivered to clients in home settings. Your responses will help contribute to a better understanding of the needs and expectations of both the 

Independent Contracted Healthcare Workers and our Contracted Clients.

Please do not submit personal health information on this website,
as requested by our company.

Certifications or Licenses in Iowa?
yes
no
Nursing Qualifications
You understand that as an independent contractor, you are self-employed. This means that you are not and will not be employed by Leichtman Heritage Health at Home.
You understand that though our company does not have a general drug-testing policy, you may be required to complete a drug test prior to working at a contracted facility. This is a condition set by the contracted facility.
Yes, I understand and acknowledge.
Certifications. You must be able to provide proof of all and must be up to date. This will include a background check. Can you provide proof of the following if asked?
What types of services are you qualified or trained to complete? (Check all that apply)
Typical age range of clients cared for. (please check all that apply)
Which environments you would rather contract to (please check all that apply)
How do you evaluate the effectiveness of your care? (please check all that apply)
What continuing education activities do you participate in? (please check all that apply)
Are you familiar with relevant legal requirements for contract services in your region?
yes
no

Thank you for taking the time to complete this questionnaire. Your insight is invaluable in shaping the future of contracted care, refining best practices, and ensuring that private contract nurses continue to provide compassionate, effective, and safe care of those who need it along with coordinating Client Contracts that match that.


How do you wish to be contacted?
Date and time
Month
Day
Year
Time
HoursMinutes
Attestation Statement: I, the undersigned, hereby attest that I am voluntarily submitting my private and personal information through the website forms provided. I acknowledge and understand the following:
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

By signing below, I confirm that I have read, understood, and agree to the above attestation regarding the submission and use of my private and personal information via website forms.

bottom of page