This application is not for employment through Saint Luke's Human Resources. Please visit the Saint Luke's Health System Careers page for current opportunities. 

Preliminary Request for Medical Staff/Allied Health Professional Application

This is a preliminary request for the hospital credentialing application for the Medical and Allied Health Professional Staff. The review process, after receipt of the application for appointment, takes approximately 90 days.

You must upload an up-to-date copy of your Curriculum Vitae/Resume. To expedite the review and authorization process, include the following information:

  • Medical school(s), or highest level degree program attended, and years of attendance
  • Post-graduate training programs attended, board certifications, specialty certifications, specialty areas, and years of attendance
  • Chronological listing of all practice affiliations since the completion of training (include dates of affiliation)

If you have questions, contact the Central Credentials Resource Department at 816-932-3293 or

Indicates required field
Not applicable for some Licensed Independent Practitioners (i.e. Master's Degree Social Worker, Psychologist). All other AHPs must complete this section. Physician sponsor must be a member of the Medical Staff at the entity(ies) to which you are applying.
Indicate which hospital you are interested in joining
If your partners and/or associates do not have clinical privileges at the Saint Luke's Health System hospital(s) where appointment is being requested, who will provide for the continuous care of your patients when you are not available?
Note: The provider must hold privileges at the Saint Luke's Health System hospital(s) to which you are applying for membership.
Group Practice Information
Provide the group practice name that you would like to be affiliated with
One file only.
3 MB limit.
Allowed types: pdf.

This does not constitute a formal application to Medical/Allied Health Professional Staff.

After the preliminary information is reviewed and approved by the Medical Staff Office, an invitation to the electronic application will be sent to the provider's email address. The credentialing contact will receive an informational email regarding the communication with the provider.