Skip Navigation
Visitor Restrictions Update: Because flu & RSV cases are on the rise, starting November 16, children 12 and younger are restricted from visiting hospitals, certain inpatient facilities, and all emergency departments. Learn more.
To request a change in classification or to request clinical privileges at any or all of the Atrium Health facilities please complete and submit this form. Please note that you must have current membership at one of the Atrium Health facilities listed.

Please Select Desired Clinical Privilege Location and/or Classification Change. Changes to the Affiliate and or Telemedicine Classification may require an update to your delineation of privileges form.

Close