COVID-2019 Alert

The latest information about the 2019 Novel Coronavirus, including vaccine clinics for children ages 6 months and older.

La información más reciente sobre el nuevo Coronavirus de 2019, incluidas las clínicas de vacunación para niños de 6 meses en adelante.


Medical Staff Submission Instructions

Before you return the application packet, please review all of your materials thoroughly for accuracy, completeness, signatures and dates.  Please note that we cannot begin processing your application until the items listed below have been received, including all check boxes, blanks and signatures completed. 

  • All professional licenses in California and other states
  • DEA certificate
  • X-Ray/Fluoroscopy certificate (required if you will use or supervise the use of this equipment)
  • Curriculum Vitae or Resume covering your work history for the last five (5) years
  • Malpractice Insurance Certificate and names of any other insurance carriers during the last five (5) years.
  • All supporting forms (Appendix A-C)
  • Copy of current Driver's License or government issued photo ID
  • 2x2 Passport Photo
  • Application Fee of $300.00 per facility

Email (scanned copy), fax or mail the completed packet and materials to:


Fax: (650) 725-0297

Mailing Address: (*Use this address to mail via US Postal Service)
Medical Staff Services
300 Pasteur Drive, M/C 5288
Stanford, CA 94305

Physical Location: (*Use this address to mail via UPS or FedEx or other courier service)
Medical Staff Services
1510 Page Mill Road
Palo Alto, CA 94304