Thank you for your interest in applying for Allied Health Professional membership at Banner Gateway Medical Center. Our goal is to provide allied health professionals with an ideal environment to practice medicine that is efficient, effective, safe and healing.

The first step in applying for Allied Health privileges is to submit the initial application request form (PDF). Once this application is received by the Banner Health Credentialing Verification Organization, you will receive a more detailed application to complete.

• Initial Application Request Form (PDF)

After submitting the initial application request form, please complete, sign and return the following documents to the Banner Gateway Medical Staff Office, 1900 N. Higley Road., Gilbert, AZ., 85234.

• Allied Health Rules and Regulations (PDF)
• Delineation of Privilege Checklists
  • Physician Assistant (PDF)
  • Nurse Practitioner (PDF)
  • Certified Registered Nurse Anesthetist (PDF)
  • Non Physician First Assistant (PDF)
  • Pathology Assistant (PDF)
  • Private Scrub/Surgical Technologist (PDF)
• Clinical Competence Peer Reference Form (PDF)
• Sponsoring Physician Statement (PDF)
• Invoice -- Staff Dues/Application Processing Fee (PDF)
• Release of Information Statement (PDF)

Please call the Medical Staff Office at (480) 543-2600 or the Banner Health CVO at (602) 640-3500 with questions.