CompHealth Locum Tenens Application

Downloadable Forms

The CompHealth application procedure involves the initial application, a skills checklist and other credentialing materials.

If you have questions or need more information, you can contact a representative at any time by calling 866.371.8311.

Two easy ways to apply for a Locum Tenens assignment with CompHealth:

Option 1: Complete the application online, print it out, initial and sign in the required places and mail or fax it to the number at the top of the application.

You do not have to complete the online application in one sitting. You may stop at any time and continue later by logging in and resuming where you left off.

In addition, you will need to print, complete and send in the Background Check Authorization form (described below).

Option 2: Download the application (pdf), print it out, complete, initial and sign in the required places and mail or fax to CompHealth.

Fax: 866-588-1627 (toll-free)

or

Attn: Locum Tenens
CompHealth
PO Box 713100
Salt Lake City, Utah 84171-3100

Adobe Acrobat Reader required.

In addition, you will need to print, complete and send in the following forms:

Specialty Skills Forms

Complete and send a skills form for each specialty you're qualified to practice in and want to pursue.

Allergy & Immunology
Anesthesiology
Cardiology
Cardiovascular Surgery
Critical Care Medicine
Dermatology
Emergency Medicine
Endocrinology
Family Practice
Gastroenterology
General Surgery
Hospitalists
Infectious Disease
Internal Medicine
Neonatology
Nephrology
Neurology
Neurosurgery
OB/GYN
Oncology / Hematology
Ophthalmology
Optometry
Orthopedic Surgery
Otolaryngology
Pathology
Pediatrics
Perinatology
Physical Medicine & Rehabilitation
Plastic Surgery
Psychiatry
Pulmonology
Radiation Oncology
Radiology
Rheumatology
Thoracic Surgery
Urology

Supplemental Claim Form (pdf) Complete a form for each malpractice claim you've experienced. Include/attach all third-party documentation for any malpractice claims (complaint/answer/judgment).

Background Check Authorization (pdf) Authorizes a criminal background check to be processed.