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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.

Please 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, you may email Shauna Guy Noel, Supervisor, Medical Staff Services.

Please click on the link below to print and complete the Delineation of Privileges form.

Floyd Medical Center - Physician Forms


Dermatoalogic Services

Emergency Medicine

Family Medicine

Hyperbaric Medicine

Internal Medicine


Pediatric General Dentistry



Radiation Oncology



Floyd Medical Center - Advanced Practice Provider (APP) Forms

 Anesthesia - APP

Certified Nurse Midwife - APP

Nurse Practitioner Breast Center - APP

Pathology - APP

Physician Assistant - APP

Radiation Oncology - APP

Wound Clinic - APP

Blank Form - APP


Thank you for your commitment to Atrium Health Floyd!