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
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!