Initial Application Request Application Access Request for Application Thank you for your interest in joining Tri-City Medical Center's Medical Staff. Please fill out the form below to receive a user name and password to our site. We look forward to working with you on the credentialing process.Name* First Last Degree*ex: MD, DO, etc.Phone*Email* California Medical License Number.*Board Certified in Speciality Area?* Yes No Are you board eligible or qualified? Yes No If you are board certified, please provide the name of the board you are certified though.Are there any special instructions needed for this initial application request? (i.e. would you like someone CC'd on the email request)
