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Alliance Therapy Services

Therapy at your doorstep, providing the best care in your home

Call Today! (409) 299-4638

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Therapy at your doorstep, providing the best care in your homeSchedule Appointment

Pre-Employment Information

New Hire Onboarding Form

This form will help streamline our HR process by providing pertinent information necessary to begin the hiring procedure in an easy to use format.

Step 1 of 4 – Contact Information

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Date
MM slash DD slash YYYY

Choose the date of contact with the clinician.
Clinician's Name*
First Last
Clinical License*
Phone Number*
Email*
Home Address*
Street Address Apartment or Unit Number City State Zip Code

Save and Continue Later

Documentation Software Experience*
- Kinnser / WellSky
- Home Care Home Base / Point Care
- Other
List Other Software
Days Available to Work
- Select All
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Coverage Territory*

Example: Specific Cities, General Areas or Hard Boundaries
Types of Physical Therapy visits to schedule
- Select All
- PT OASIS – Kinnser
- PT Assessments – Kinnser
- PT Visits – Kinnser
- PT OASIS – HCHB
- PT Assessments – HCHB
- PT Visits – HCHB
Types of Occupational Therapy visits to schedule
- Select All
- OT Assessments – Kinnser
- OT Treatments – Kinnser
- OT Assessments – HCHB
- OT Treatments – HCHB
Types of Speech Therapy visits to schedule
- Speech Pathologists perform Assessments and Treatments
Types of Physical Therapist Assistant visits to schedule
- PTA’s can only perform treatments
Types of Occupational Therapy Assistant visits to schedule
- COTA’s can only perform treatments

Save and Continue Later

Employment Status*
Visit Rate*
Provide the per visit reimbursement discussed with the clinician.
Projected Payroll
Projected Payroll

Save and Continue Later

Special Notes
Email
This field is for validation purposes and should be left unchanged.

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Patient Referral Form

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