Atrium Health Surgery Center Indian Trail forms
Please follow the steps below to complete Phase I - Clinical Privileges Update of the reappointment process for Atrium Health Surgery Center Indian Trail.
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.
- 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
Indian Trail Obstetrics and Gynecology
Indian Trail Oral and Maxillofacial
Advanced Practice Provider (APP) Forms
Indian Trail Physician Assistant (P.A.)
Indian Trail Certified Registered Nurse Anesthetist (CRNA)
Thank you for your commitment to Atrium Health!