Through our program MedChek, you may apply for privileges by completing the universal application form. The application fee for our services is discussed on the cover sheet of the application and varies according to each entity to which you are applying. MedChek has the responsibility to verify all the data contained on the application as determine by the entity to which you are applying. Please be sure all questions are answered completely, i.e., complete addresses with zip codes and contact names where applicable. This will definitely expedite the credentialing process. (Our clients will not accept "see CV" in place of completing the application.) The credentialing process will take at least six to eight weeks to complete. The universal application may be printed out, completed and mailed to MedChek with the appropriate attachments. If you prefer to have the information mailed, please e-mail your request to firstname.lastname@example.org or fax to 513-721-4378.
Credentials Keepers clients may also complete the universal application form. The information provided will allow Credentials Keepers to complete other applications on the client's behalf.
Select the appropriate application to download. Please see the application for a list of our existing clients. You must have Adobe Acrobat Reader to view the applications. Click here if you need to download a copy of Acrobat Reader.
Universal Application form for MDs, DOs, DCs, and DPMs
Allied Health Application form