The Organizational Clinic Support

Description Contractor Options Instructions Action
Referral Contractor (RC) Customer Relationship Contractor (CRC) Performance Improvement Contractor (PIC)
Application Form Complete and submit application
Agreement Read, complete and submit agreement
Driver’s License Scan and upload copy of driver’s license
Educational Certificate Scan and upload copy of educational certificate
Form W-9 Print, complete, scan and upload copy of W-9 Form
Direct Deposit Form Complete and submit Direct Deposit Form