Atrium Health Surgery Center Shelby Forms

Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process for Atrium Health Surgery Center Shelby privileges.

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

• Print and Complete the Delineation of Privileges (DOP) that reflects your specialty/current practice.
• Return the form(s) to the coordinator assigned to you.
• Allison Eury - Allison.Eury@AtriumHealth.org
• Demetrice Ford - Demetrice.Ford@AtriumHealth.org

If you have additional questions, you may email Staci Hightower, Supervisor.

Physician Forms

Shelby Anesthesia

Shelby Colorectal

Shelby Dermatology

Shelby Endoscopy

Shelby General Surgery

Shelby Gynecology

Shelby Hand Surgery

Shelby Neurosurgery

Shelby Ophthalmology

Shelby Oral Surgery

Shelby Orthopaedics

Shelby Otorhinolaryngology

Shelby Pain Management

Shelby Plastic Surgery

Shelby Podiatry

Shelby Urology

Advanced Clinical Practitioner (ACP) Forms

Shelby APP Nurse Practitioner (N.P.)

Shelby APP Physician Assistant (P.A.)

Shelby APP Certified Registered Nurse Anesthetist (CRNA)

Thank you for your commitment to Atrium Health!