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Visitor Guideline Update: Due to respiratory virus season, children 12 and under are not permitted to visit patients in multiple settings. Additionally, everyone is required to mask in patient rooms and other designated areas. Learn more.

Follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process.

If you wish to keep a privilege that is attached to maintenance criteria, you must provide proof of that maintenance criteria in order to maintain the privilege.

If you are requesting a privilege you currently do not have, you must meet the initial criteria for that privilege.

If you have additional questions, email Shauna Guy Noel, Supervisor, Medical Staff Services.

Click on the link below to print and complete the Delineation of Privileges form. If you form is not listed, visit the Floyd Medical Center facility page.

Physician Forms


Emergency Medicine

Family Medicine


Internal Medicine


Pediatric General Dentistry





Advanced Practice Provider (APP) Forms

Anesthesia - APP

Blank Form - APP

Thank you for your commitment to Atrium Health Floyd!