Contact Us – Palmetto Dental Personnel, Inc

Name *
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Last
Email *
Client or Applicant
Comment or Message *

Job Title *
Temporary or Permanent Position? *
Your Name *
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Last
Dentist/Practice Name *
Email *
Phone *
Alternate Phone
Additional Information

Employee Name *
First
Last
Position Title *
Assignment Start Date(s) *
Dependability
Attitude
Knowledge of Skills Requested
Quality of Work
Communication Skills
Patient Interaction
Initiative and Motivation
Overall Rating
Arrives on time and ready to work
Additional Comments
Would you request this employee again?
Evaluator Name *
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Last
Evaluator Title *
Dentist/Practice Name *
Phone *
Email *

Practice Name *
Associate(s) or Partner(s) *
Office Phone *
Office Fax
Email *
Doctor's Home Phone *
Doctor's Mobile/Beeper Number *
Office Manager *
First
Last
Office Manager Phone Number *
Receptionist *
First
Last
Receptionist Phone Number *
Assistant *
First
Last
Hygenist *
First
Last
Office Hours
Prophy Appointment Time Adult
Prophy Appointment Time Child
Prophy Appointment Time New
Frequency of BWX Procedure
Frequency of Fmx/Pano Procedure
Frequency of Fluoride Procedure
Office Equipment
Prophy Jet
Cavitron
Titan
Microwave
Refrigerator
Automatic Developer
Panorex
Digital X-Ray
Name of Computer Software
Name of Liability Insurance Company *
Does it provide an Umbrella Clause for Temporary Personnel? *
Additional Comments
We provide 24-hour emergency dental staffing service.

Contact Janet Saranchuk

Palmetto Dental Personnel, Inc.
Serving South Carolina and Oregon

800-438-7470 office/toll-free
503-404-3385 mobile

Please contact us with any questions or comments using the form below: