Application Forms

Physician

Download the applicable forms from the list below.* Print each form and fill it out. You must initial and sign every form where requested. Fax or mail to Weatherby Locums, using the contact information below.

• Application Form
• Document Checklist
• Clinical Capabilities Form:
  • Please provide a form for EACH specialty in which you are qualified to practice.
    Select a specialty Allergy and Immunology Anesthesiology Cardiology Cardiovascular Surgery Critical Care Medicine Dermatology Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Gastroenterology General Surgery Hematology Hospitalist Infectious Diseases Internal Medicine Neonatology Nephrology Neurology Neurosurgery Obstetrics and Gynecology Oncology Orthopedic Surgery Otolaryngology Pathology Pediatric Critical Care Medicine Pediatric Hospitalist Pediatrics Perinatology Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Pulmonary Radiation Oncology Reproductive Endocrinology and Infertility Rheumatology Thoracic Surgery Urology Vascular Surgery
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• Malpractice Supplemental Claims Form
• Background Check Authorization Form
• Physician Reimbursement Policy
• Travel Profile Form
• Direct Deposit Form

• Release and Authorization (Print and complete upon request from your recruiter.)

Fax or mail to Weatherby Locums at:

FAX: 1-866-588-0085
MAIL: Weatherby Locums
6451 North Federal Highway, Suite 800
Fort Lauderdale, FL 33308