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Basic information
Full Name
Last Name
Email
Phone Number
Address
City
Zip code
LinkedIn Profile
Experience and background
Do you have sales experience?
Yes
No
What is sales?
Do you have experience in medical sales?
Yes
No
Briefly describe your previous sales experience
What industries have you worked in previously? (Check all that apply)
Medical Devices
pharmaceuticals
Biotechnology
Hospitals or Clinical sales
Wound care/ Skin care
Orthopedics/ Sports medicine
Home health services
Skilled nursing facilities
Insurance/ healthcare administration
Medical Devices
Surgical/ Operating room supplies
Laboratory services
Physical Therapy/ rehabilitation
Health IT/ EMR software
General B2B/ Retail Consumer Sales
Other
None of the above
Current work status
Full-time
Part-time
Self-employed
Unemployed
Other
Why do you want to become a RxHealing rep?
What excites you about RxHealing?
Skills and readiness
Are you comfortable working on 100% commission-based? (1099 contractor)
Yes
No
I'd like more information
Are you available to dedicate at least 15–20 hours per week to this role?
Yes
No
Flexible
Are you willing to visit provider offices in-person as part of your outreach strategy?
Yes
No
I'll think about it
How comfortable are you using CRM tools?
Very Comfortable
Some-what Comfortable
Never used a CRM
What is a CRM
Next steps
When can you start?
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
Year
Have you attended one of our Blueprint overview calls?
Yes
Not yet
How did you hear about us?
A friend
Social media
Indeed/ Zip recruiter
Our website
Google search
Trade publication
RxHealing employee
Email Newsletter
If you heard about us from a friend please provide their name
Name of RxHealing Rep
Please attach your resume
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