Getting started is now even easier. 

You may submit your information electronically by simply choosing the "Physician Packet" in the "Online Forms" section, and then following the step by step instructions. Your information will be saved so you may return to the form time and time again to edit and update your information if necessary.

If you prefer to submit your information in paper form, simply click on your profession in the "Paper Forms" section, print and complete the order form, and then fax (904-339-9075) or mail it to our office. If you have a current CV that includes month and year or any other documentation that provides the same information that we ask for on our form, you may submit it in place of completing our form. Finally, if you don't have the time to complete our packet just give us a call. We can obtain all of the information that we need over the phone.

Online Forms    

• Physician Packet

Online form payment options: We accept payment via credit card only.

Paper forms

• Physician Packet (this form must be hand written)

• Physician Packet (this form can be typed online and then printed, not recommended for dial-up internet users)

• Nurse Packet (this form must be hand written)

Paper form payment options: We accept payment via credit card, check, or money order. When using a credit card you may provide your credit card information on the last page of the paper form, or if you are only applying to one state you may pay online via "Google Checkout." When paying with a check or money order please mail it to the following address - 3 W. Garden Street, Suite 700 Pensacola, Florida 32502.