Acknowledgement Form

Thank you for completing Clark Memorial's online New Provider Orientation. Please complete and acknowledge the following information in order to receive your completion certificate. A completion notice will also be electronically sent to the Clark Memorial Medical Staff Office to be attached to your application.

As a new medical staff applicant, you are required to completed this online orientation prior to exercising privileges at a Clark Memorial Hospital facility. 

Please remember to print, review, sign and provide required documents as listed in the Provider Resources menu to the Medical Staff Office as directed. Your orientation will not be completed until the Medical Staff office receives these documents.

*Please confirm that you have reviewed and fully understand the following materials: