Credentialing Process

Peoria Medical Society

7700 N. Harker Dr.
Suite D
Peoria, IL 61615

Credentialing Process:

A important service provided by the Peoria Medical Society is to verify the credentials of those who wish to obtain privileges in the Peoria area hospitals and other health care facilities. Any questions please call or email Diane or Roxanne.

Instructions:
Please download all of the necessary forms below, complete them in their entirety, sign, and return with all supporting documents to the Peoria Medical Society office to begin the credentialing process.

Health Care Professional Credentialing and Business Data Gathering Form (35 pages)
Instruction Letter - Physicians (2 pages)
Instruction Letter - Allied Health Professionals (3 pages)
Fee Letter (1 page)
Request for Additional Information (3 pages)
Consent for Release (1 page)
Addendum to Application (4 pages)
Statement of Applicant (2 pages)
Kroll Background Release (1 page)
Motor Vehicle Release form (1 page)
CME Statement form (1 page)
Physician's Health Confirmation Statement (1 page)

If you have any questions or problems call the Medical Society (309) 692-1192