Initial Appointment Application:                               Application for consideration at ASA Partners

Initial Appointment Application              (393KB pdf)

Document Checklists:
List of items needed for credentialing

      Physican Applicants
      CRNA Applicants
      Physician Assistant Applicants
      Nurse Practioner Applicants  

Physician Document Checklist               (99KB pdf)
CRNA Document Checklist                    (95KB pdf)       
PA Document Checklist                        (96KB pdf)        
NP Document Checklist                        (99KB pdf)

ASA Consent of Release Form:
Authorization to obtain background information  

Consent of Release                              (99KB pdf) 

IRS W-9 Tax Form
Taxpayer information for compensation

W-9 Form                                            (72KB pdf)

Please send completed forms to:  FAX: (800)211-1078 - or - EMAIL: credentials@asapartners.net