Request Time Off

Is this request for a shift in the next 24 hours?

Yes

No

Since your request is for a shift within the next 24 hours, please contact your staffer via phone ASAP, Please do not text!

Your Name

First

Last

Your Email

Who staffs the patient(s) for this request?

Teresa

Vicki

You may pick one or both, if requesting for multiple patients.

Please list the patient name(s) along with the dates and times you would like off.

I acknowledge that I am submitting this request via the NPLH website and is NOT CONFIRMED until I have received an email confirming that I have been removed from the shift(s).

For your request to be complete, you must receive a confirmation email from your staffer acknowledging that you have been removed from your shift(s).

If you do not receive a confirmation email within 1-2 business days please contact your staffer directly!

Since your request is for a shift within the next 24 hours, please contact your staffer via phone ASAP, Please do not text!