Physician reviewer application packet
Thank you for your interest in the physician peer review process at Acumentra Health. If you meet the physician reviewer qualifications, download and complete the following forms (contact us if you prefer to receive the forms by mail) :
- Reviewer certification form (Word, April 2011)
- Acumentra Health confidentiality and conflict of interest agreement (PDF, February 2010)
- W9 form (download from www.irs.ustreas.gov/pub/irs-pdf/fw9.pdf )
- Physician Membership Enrollment Form (Word, October 2010)
Mail the forms and information to
Denise Phillips
Acumentra Health
2020 SW Fourth Avenue, Suite 520
Portland, OR 97201-4960
Do not submit any of this information to us by email. We cannot ensure the privacy of information that you submit by email.
We appreciate your interest and look forward to hearing from you.
Last updated November 15, 2011