Requesting an Application for Medical Staff Membership

Please contact the Medical Staff Office to request an application, referred to as a “Request for Consideration – RFC” for staff membership and clinical privileges for your specific specialty. Contact Carla Ridley at (850) 325-5911 or via email:

Step 1:

You will need to call or email Carla Ridley in order to start the credentialing process. She will then send a pre application to get some basic knowledge such as full legal name, social security number, and National Practitioner Identification number. When you return the pre application to Carla Ridley by fax, email, or in person it will submitted and you should receive the online application through your email within 48 hours. The application fee can be paid by check. Please see more about application fees in the Frequently Asked Questions section. Applications that do not include the application fee will not be processed until the fee has been received.

Step 2:

Once you have received your application packet, read Bylaws, HCA Code of Conduct, Mission, Vision and Values Statement. All applicants should thoroughly review these documents prior to requesting staff membership and/or clinical privileges. You will be asked to sign an attestation that you have read and fully understand and agree to comply with the Medical Staff Bylaws, Rules and Regulations, and applicable policies.

Step 3:

Once you have fully completed the Request for Consideration, please submit the application. The online application will go directly to the Credentialing Processing Center. Please send the supplemental documents to the Medical Staff Office by fax, email, or in person. If you have any problems with the online application please do not hesitate to call at any time.

By accepting and completing a Request for Consideration and returning it with the 350 dollar application fee, you acknowledged that you have reviewed and understand the Medical Staff Bylaws, Rules and Regulations, and Code of Conduct. You further agree to be bound by the same, both at the time of application and throughout your appointment and reappointment terms. YOU ARE STRONGLY URGED TO PRINT THESE DOCUMENTS FOR FUTURE REFERENCE AND BE FAMILIAR WITH THEM.