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CCVS Application
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Application

The $350 origination fee is a one-time fee ($750 for Locum Tenens and $250 for members of the Richmond Academy of Medicine). A maintenance fee is charged to ensure regular updated files for re-appointments to hospitals and health care plans, regardless of the number of entities.

OPTION 1 - In Print
Click below to download and print the application. Complete it and mail it with the requested attachments, the signed attestation page, and your payment of $350 ($750 for Locum Tenens and $250 for members of the Richmond Academy of Medicine) to CCVS at:


CCVS
2821 Emerywood Pkwy
Suite 200
Richmond, Virginia 23294

804.643.2287 Phone
804.622.8144 Fax

 

You may pay by MasterCard, VISA, American Express, or check.  Click here to download application


OPTION 2 - On Line
Available Soon! 

 

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