Wapiti Medical Group - Connecting Quality Healthcare to Rural America
1-888-733-4428
Preliminary Application

Instructions:

  1. Fill out the web form, which is the preliminary application.
  2. Please Fax (605-432-5669) or e-mail a copy of current CV.
  3. Complete our full application once your preliminary application is approved.

Denotes Required Field

Name:
Address:
City:
State:    * ZIP:
Phone:
Fax:
E-mail:
   
Degree:
Medical School:
Residency:
Boards:
Best way to contact :
State Licenses :
Malpractice suits filed :
License revocations or restrictions :
   
Type of position desired:
   
 

Word DocumentDownload Application

After the Preliminary Application is approved, you will be sent a Wapiti Application for completion. You may also download it by clicking the link above.

Fill out the form on your computer by entering text into the editable regions. Return the completed form to us by e-mail or fax.

 

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