Physician Application Request
Click on the link below to open the Request for Application form and instructions for requesting an application to the Samaritan
Instructions for completing Medical Staff Request for Application:
- Open application using link.
- Complete application electronically.
- Sign the document using a digital signature (you will be prompted to create a new digital signature or use an existing signature file).
- Save a copy of the document for your records (you will be prompted to save after affixing your digital signature).
- You may send you application and the requested documents by email or mail:
- Email: firstname.lastname@example.org
- Mail: Samaritan Regional Health System
Kelly Schroeder, Medical Staff Coordinator
1025 Center St.
Ashland, OH 44805
Contact Kelly Schroeder with any questions at 419-207-2445 or email@example.com.