Physician Partner Application

1. Personal Info

2. Medical Credentials

3. Experience

4. Availability

5. Partnership Goals

6. Agreement

Personal Information

Tell us about yourself. All information is kept strictly confidential.

First Name *

Last Name *

Email Address *

Phone Number *

Country

State

City

Address *

Postal Code *

How did you hear about us?

Preferred Contact Method

Step 1 of 6

Medical Credentials

We verify all credentials before onboarding. Please provide accurate information.

Medical Degree *

Medical School Attended *

Year of Graduation

Residency Completed *

Fellowship (if applicable)

Board Certification(s)

Medical License Number * States * License Expiration Date * License File *

Click + to add another state, license number, expiry date and file together

Do you have active malpractice insurance? *

Have you ever had a license suspended or revoked? *

                Note:

                DrsOnCalls will conduct a standard credential verification including license check,
                board certification verification, and malpractice history review as part of the onboarding process.

Step 2 of 6

Availability & Schedule

There are no strict minimums to start. Tell us honestly what works for your lifestyle.

How many hours per week can you commit? *

Preferred time of day for consultations

Which days are you generally available? (check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Do you anticipate any extended periods of unavailability in the next 12 months?

Device(s) you have available for consultations

Internet connection quality at home

How soon are you ready to begin? *

Step 4 of 6

Acknowledgment & Submission

Please read and acknowledge the terms below before submitting your application.

Application Acknowledgment & Terms of Review

By submitting this application, I acknowledge and agree to the following:

1. Accuracy of Information: All information provided in this application is accurate and complete to the best of my knowledge.

2. Credential Verification: I consent to DrsOnCalls verifying my medical license, board certifications, and malpractice history.

3. Confidentiality: All information shared in this application will remain strictly confidential.

4. Non-Binding: Submission of this application does not guarantee acceptance into the Physician Partnership Program.

5. Equity Terms: Any equity participation is subject to a formal legal agreement and vesting schedule.

6. Compliance: Partnership structures are subject to healthcare compliance and legal review.

7. Response Timeline: DrsOnCalls will review your application within 48 business hours.

Full Legal Name (type to sign) *

Date *

I confirm that all information in this application is accurate and complete *

I consent to credential verification as part of the application process *

I understand this application is non-binding and subject to a formal partnership agreement *

I agree to receive email communications from DrsOnCalls regarding my application

                What happens next:
                After submitting, our team will review your application within 48 hours and contact you regarding next steps.
            

Step 6 of 6

🌟

Application Submitted!

Thank you for applying to become a Founding Physician Partner at DrsOnCalls. Our team will personally review your application and respond within 48 hours.

Status✓ Under Review

Response timeWithin 48 hours

Check your emailConfirmation sent

Questions?hello@drsoncalls.com

In the meantime, visit DrsOnCalls.com to learn more about the platform.

Your license is your

Application Acknowledgment & Terms of Review

Application Submitted!

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Your license is yourinvestment.

Application Acknowledgment & Terms of Review

Application Submitted!

Quick Links

Get In Touch

Your license is your