Application Our membership application and other forms, described below, are available the Portable Document Format (PDF).  In order to view and print them, you will need Adobe® Acrobat® Reader version 4.0 or later.  You may download this program for free by clicking here, which will give you the download information in a new browser window. Membership Application Download Options: Membership Application Only (993 KB) Membership Application w/ Attachments (4.71 MB) Checklist Applicant should complete and return the following: Texas Common Credentialing Application Part I: Personal Information Office Information Education Training Licensure Certifications and Registrations Academic Appointments Facilities Affiliations Professional Work History Professional Liability Insurance, Malpractice Claims History Case Specific Liability Claims Information Current Professional Practice Required Attachments: Current State License Texas Controlled Substances Registration Certification Current Federal DEA Registration Current Professional Liability Insurance Face Sheet Signature Section Texas Common Credentialing Application Part II: Peer References Continuing Medical Education Information Attestation Questions Doctor's Verification and Release Form Other Requested Information Documents Requested: Curriculum Vitae and CME hours Board Certification Certificate Medical School Certificate Internship & Residency Certificates (All) Fellowship Certificates (If Applicable) All Mid-Level Practitioners Licenses ECFMG (If Applicable) Current Texas Medical License Current DEA Current DPS Current Certificate of Insurance Current General Liability Certificate of Insurance Narrative on Malpractice Cases (If Applicable) W-9 Tax I.D. Number Certification Please Note: All sheets of application must be initialed and dated! Also enclose: $350 non-refundable application fee Please make the checks payable to Physicians Contracting Organization of Texas, and mail the information to: Physicians Contracting Organization of Texas 935 Baxter, Suite 101 Tyler, Texas 75701 (903) 526-3268 Please note: incomplete applications will delay the credentialing process!