Request for Medical Staff Application (Pre-application) - tgh 2026

1. Click ‘Get Form’ to open the Request for Medical Staff Application in our editor.
2. Begin by entering today’s date at the top of the form. Fill in your full name, including any relevant titles (MD, DO, etc.), and your Social Security Number.
3. Complete your office address details, including suite number, city, state, and zip code. Don’t forget to provide your office telephone and fax numbers along with your email address.
4. Next, fill out your residence address and contact information. Indicate where you would like the application mailed by checking either 'Office' or 'Residence'.
5. Provide details about your medical group affiliation and residency completion year. Indicate if you are board certified and include relevant years.
6. Answer questions regarding your Florida medical license status and any other hospitals you are currently affiliated with. Be thorough to avoid processing delays.
7. Finally, ensure all required documents are attached before submitting the application along with the $50 pre-application fee.

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