Pre-ApplicationCompletion of Trinity Hospital's Medical Staff Pre-Application Form is required. Completion of the Medical Staff Pre-Application Form in no way obligates the hospital and/or medical staff to grant medical staff membership or privileges.
Download the Medical Staff Pre-Application
Pre-Application Form InstructionsThis pre-application form cannot be submitted online, but may be mailed or faxed. If faxed, follow-up with mailing the hard copy. The following are prerequisites for final approval of your privileges, but can be submitted with the pre-application, if available.
- Current license to practice medicine in state of current medical practice.
- Current Federal DEA Registration certificate.
- Certificate of professional liability insurance coverage.
- ECFMG certificate (if foreign medical graduate)
- Medical Diploma
- Internship/Residency/Fellowship certificates
- Evidence of board certification status
- A complete curriculum vitae