Apply for Membership

You will need the following information to complete your application for medical staff membership:

  • All professional licenses in Oregon, Washington and other states, as applicable.
  • DEA certificate as applicable
  • Curriculum vitae or résumé covering education and work history, along with a written explanation of any gaps in practice greater than 60 days
  • Malpractice insurance, certificate of insurance, any other insurance carriers and policy numbers held within the past five years

Request Application