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Health Professional Registration Form
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Contact Information
First Name
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Last Name
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Currently Resides In
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FL
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IN
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NC
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NH
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OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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Phone
Visa Status
US Citizen
Permanent Resident
Resident Alien
H1-B
J-1
Other
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Account Information
Email Address
Email Address is required
Email Address must be valid
Confirm Email Address
Email Address and Confirm Email must match
Password
Password must be between 8 and 20 characters in length. Passwords are case-sensitive.
Password is required
Password must be at least 5 and less than 30 characters
Confirm Password
Password and Confirm Password must match
Discovery Source
National Rural Health Day
Practice Match Virtual Career Fair - November 5
Web Search
Friend/Colleague
Social Media
AHEC
Date Available
Date Available is required
Type of Healthcare Profession
Acupuncture
Administration
Anesthesia Technician
Athletic Trainer
Audiologist
Behavioral Health Technician
Behavioral Health Therapist
Business and Finance
Business Office
Cardiology Technician
Case Manager
CEO - Chief Executive Officer
Certified Nurse Midwife
Certified Registered Nurse Anesthetist
CFO - Chief Financial Officer
Chief Medical Officer/Medical Director
Chief Operating Officer
Chiropractic Medicine
Clinic Director
Clinical Mental Health Counselor
Clinicial Nurse Specialist
CNA - Certified Nurse Assistant
CNO - Chief Nursing Officer
Community Health Worker
Dental Assistant
Dental Hygienist
Dental Technician
Dental Therapist
Dentist - Director
Dentist - Endodontics
Dentist - General
Dentist - Oral and Maxillofacial
Dentist - Orthodontics
Dentist - Pediatric
Dentist - Prosthodontics
Dentist - Public Health
Diagnostic Medical Sonographer
Dietitian
DNP - Doctor of Nursing Practice
ECG Technician
Echocardiography
EMS/EMT
Epidemiologist
Exercise Physiologist
Health Educator
Health Information Manager
Health Information Technology
Health Navigator
Health Service Psychologist
HIT Network Director
Home Health Aide
Human Resources
Imaging/Radiology
Infection Preventionist
Information Systems
Lab Manager
Laboratory Technician
Licensed Psychological Associate
LPC - Licensed Professional Counselor
LPN - Licensed Practical Nurse
MA - Medical Assistant
Maintenance and Operations
Maintenance Technician
Mammography Technician
Management/Supervisor
Marketing and Public Relations
Marriage and Family Counseling
Materials Management
Medical Examiner
Medical Informatics
Medical Office Assistant
Medical Technician
Medical Transcription
Network Director
Nuclear Medicine Technician
Nurse Assistant
Nurse Practitioner (NP) - Adult/Geriatric
Nurse Practitioner (NP) - Allergy & Immunology
Nurse Practitioner (NP) - Anesthesiology
Nurse Practitioner (NP) - Cardiovascular Disease
Nurse Practitioner (NP) - Child & Adolescent Psychiatry
Nurse Practitioner (NP) - Colon & Rectal Surgery
Nurse Practitioner (NP) - Critical Care Medicine
Nurse Practitioner (NP) - Dermatology
Nurse Practitioner (NP) - Diagnostic Radiology
Nurse Practitioner (NP) - Emergency Medicine
Nurse Practitioner (NP) - Endo, Diabetes & Metabolism
Nurse Practitioner (NP) - Family Medicine
Nurse Practitioner (NP) - Family Medicine w/OB
Nurse Practitioner (NP) - Gastroenterology
Nurse Practitioner (NP) - General Practice
Nurse Practitioner (NP) - General Surgery
Nurse Practitioner (NP) - Gynecology
Nurse Practitioner (NP) - Hematology
Nurse Practitioner (NP) - Hematology/Oncology
Nurse Practitioner (NP) - Hospice and Palliative Care
Nurse Practitioner (NP) - Hospitalist
Nurse Practitioner (NP) - Infectious Disease
Nurse Practitioner (NP) - Internal Medicine
Nurse Practitioner (NP) - Interventional Cardiology
Nurse Practitioner (NP) - Maternal/Fetal Medicine
Nurse Practitioner (NP) - Med / Peds
Nurse Practitioner (NP) - Medical Genetics
Nurse Practitioner (NP) - Medical Oncology
Nurse Practitioner (NP) - Naturopathic Medicine
Nurse Practitioner (NP) - Neonatology
Nurse Practitioner (NP) - Nephrology
Nurse Practitioner (NP) - Neurological Surgery
Nurse Practitioner (NP) - Neurology
Nurse Practitioner (NP) - Non-Invasive Cardiology
Nurse Practitioner (NP) - Nuclear Medicine
Nurse Practitioner (NP) - Obstetrics & Gynecology
Nurse Practitioner (NP) - Oncology
Nurse Practitioner (NP) - Ophthalmology
Nurse Practitioner (NP) - Orthopedic Surgery
Nurse Practitioner (NP) - Orthopedics
Nurse Practitioner (NP) - Other
Nurse Practitioner (NP) - Otolaryngology
Nurse Practitioner (NP) - Pain Management
Nurse Practitioner (NP) - Palliative Care
Nurse Practitioner (NP) - Pathology
Nurse Practitioner (NP) - Pediatric Cardiology
Nurse Practitioner (NP) - Pediatric Pulmonology
Nurse Practitioner (NP) - Pediatric Surgery
Nurse Practitioner (NP) - Pediatrics
Nurse Practitioner (NP) - Pediatrics Critical Care
Nurse Practitioner (NP) - Physical Medicine & Rehabilitation
Nurse Practitioner (NP) - Plastic Surgery
Nurse Practitioner (NP) - Podiatry
Nurse Practitioner (NP) - Preventive Medicine
Nurse Practitioner (NP) - Psychiatry
Nurse Practitioner (NP) - Pulmonary Critical Care
Nurse Practitioner (NP) - Pulmonary Disease
Nurse Practitioner (NP) - Radiation Oncology
Nurse Practitioner (NP) - Radiology
Nurse Practitioner (NP) - Rheumatology
Nurse Practitioner (NP) - Thoracic Surgery
Nurse Practitioner (NP) - Urgent Care
Nurse Practitioner (NP) - Urology
Nurse Practitioner (NP) - Vascular Surgery
Nurse Practitioner (NP) - Women's Health
Nursing Home Administrator - NHA
Nutritionist
Occupational Therapist
Occupational Therapy Assistant
Office Manager
Ophthalmic Technician
Optometrist
OR Technician
Orthopedic Technician
Other
Pathology Assistant
Patient Access Representative
Peer Recovery Specialist
Pharmacist
Pharmacy Technician
Phlebotomist
Physical Therapist
Physical Therapy Assistant
Physician - Addiction Medicine
Physician - Addiction Psychiatry
Physician - Adult/Geriatric
Physician - Allergy & Immunology
Physician - Anesthesiology
Physician - Cardiovascular Disease
Physician - Child & Adolescent Psychiatry
Physician - Colon & Rectal Surgery
Physician - Critical Care Medicine
Physician - Dermatology
Physician - Diagnostic Radiology
Physician - Emergency Medicine
Physician - Endo, Diabetes & Metabolism
Physician - Family Medicine
Physician - Family Medicine w/OB
Physician - Gastroenterology
Physician - General Practice
Physician - General Surgery
Physician - Gynecology
Physician - Hematology
Physician - Hematology/Oncology
Physician - Hepatologist
Physician - Hospice and Palliative Care
Physician - Hospitalist
Physician - Infectious Disease
Physician - Internal Medicine
Physician - Interventional Cardiology
Physician - Maternal/Fetal Medicine
Physician - Med / Peds
Physician - Medical Genetics
Physician - Medical Oncology
Physician - Naturopathic Medicine
Physician - Neonatology
Physician - Nephrology
Physician - Neurological Surgery
Physician - Neurology
Physician - Non-Invasive Cardiology
Physician - Nuclear Medicine
Physician - Obstetrics & Gynecology
Physician - Oncology
Physician - Ophthalmology
Physician - Orthopedic Surgery
Physician - Orthopedics
Physician - Other
Physician - Otolaryngology
Physician - Pain Management
Physician - Palliative Care
Physician - Pathology
Physician - Pediatric Cardiology
Physician - Pediatric Pulmonology
Physician - Pediatric Surgery
Physician - Pediatrics
Physician - Pediatrics Critical Care
Physician - Physical Medicine & Rehabilitation
Physician - Plastic Surgery
Physician - Podiatry
Physician - Preventive Medicine
Physician - Psychiatry
Physician - Pulmonary Critical Care
Physician - Pulmonary Disease
Physician - Radiation Oncology
Physician - Radiology
Physician - Rheumatology
Physician - Sports Medicine
Physician - Surgical Oncology
Physician - Thoracic Surgery
Physician - Urgent Care
Physician - Urology
Physician - Vascular Surgery
Physician - Women's Health
Physician Assistant (PA) - Adult/Geriatric
Physician Assistant (PA) - Allergy & Immunology
Physician Assistant (PA) - Anesthesiology
Physician Assistant (PA) - Cardiovascular Disease
Physician Assistant (PA) - Child & Adolescent Psychiatry
Physician Assistant (PA) - Colon & Rectal Surgery
Physician Assistant (PA) - Critical Care Medicine
Physician Assistant (PA) - Dermatology
Physician Assistant (PA) - Diagnostic Radiology
Physician Assistant (PA) - Emergency Medicine
Physician Assistant (PA) - Endo, Diabetes & Metabolism
Physician Assistant (PA) - Family Medicine
Physician Assistant (PA) - Family Medicine w/OB
Physician Assistant (PA) - Gastroenterology
Physician Assistant (PA) - General Practice
Physician Assistant (PA) - General Surgery
Physician Assistant (PA) - Gynecology
Physician Assistant (PA) - Hematology
Physician Assistant (PA) - Hematology/Oncology
Physician Assistant (PA) - Hospice and Palliative Care
Physician Assistant (PA) - Hospitalist
Physician Assistant (PA) - Infectious Disease
Physician Assistant (PA) - Internal Medicine
Physician Assistant (PA) - Interventional Cardiology
Physician Assistant (PA) - Maternal/Fetal Medicine
Physician Assistant (PA) - Med / Peds
Physician Assistant (PA) - Medical Genetics
Physician Assistant (PA) - Medical Oncology
Physician Assistant (PA) - Naturopathic Medicine
Physician Assistant (PA) - Neonatology
Physician Assistant (PA) - Nephrology
Physician Assistant (PA) - Neurological Surgery
Physician Assistant (PA) - Neurology
Physician Assistant (PA) - Non-Invasive Cardiology
Physician Assistant (PA) - Nuclear Medicine
Physician Assistant (PA) - Obstetrics & Gynecology
Physician Assistant (PA) - Oncology
Physician Assistant (PA) - Ophthalmology
Physician Assistant (PA) - Orthopedic Surgery
Physician Assistant (PA) - Orthopedics
Physician Assistant (PA) - Other
Physician Assistant (PA) - Otolaryngology
Physician Assistant (PA) - Pain Management
Physician Assistant (PA) - Palliative Care
Physician Assistant (PA) - Pathology
Physician Assistant (PA) - Pediatric Cardiology
Physician Assistant (PA) - Pediatric Pulmonology
Physician Assistant (PA) - Pediatric Surgery
Physician Assistant (PA) - Pediatrics
Physician Assistant (PA) - Pediatrics Critical Care
Physician Assistant (PA) - Physical Medicine & Rehabilitation
Physician Assistant (PA) - Plastic Surgery
Physician Assistant (PA) - Podiatry
Physician Assistant (PA) - Preventive Medicine
Physician Assistant (PA) - Psychiatry
Physician Assistant (PA) - Pulmonary Critical Care
Physician Assistant (PA) - Pulmonary Disease
Physician Assistant (PA) - Radiation Oncology
Physician Assistant (PA) - Radiology
Physician Assistant (PA) - Rheumatology
Physician Assistant (PA) - Thoracic Surgery
Physician Assistant (PA) - Urgent Care
Physician Assistant (PA) - Urology
Physician Assistant (PA) - Vascular Surgery
Physician Assistant (PA) - Women's Health
Physician Recruiter
Podiatrist
Psychology
Psychology - Child
Public Health
Public Health Administrator
Public Health Nurse
Public Health Planner
Quality/Risk Manager
Radiation Therapist
Radiology Technician
Radiology Transcription
Registered Vascular Tech
Respiratory Care Therapist
RN - Manager/Supervisor
RN - Registered Nurse
Sleep Lab Technician
Social Service Specialist
Social Worker
Social Worker - Clinical
Speech Language Pathologist
Speech Therapist
Substance Abuse Counselor
Surgical Technician
Ultrasound Technician
Veterinarian
Type of Profession is required
Safety Net Credential
AHEC Scholar
Certified Rural Health Clinic Professional
This field is for professionals that have undergone certain safety-net credential programs. Please leave blank if not applicable.
Click here
for more information on supported credentials.
Notification Preference
None
Daily
Weekly
Notification Preference is required
Locations of Interest
Alaska
Alabama
Arkansas
Arizona
California
Cherokee Nation
Colorado
Connecticut
District of Columbia
Delaware
Dept of Veterans Affairs
Florida
Georgia
Hawai`i
Iowa
Idaho
Indian Health Service
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
You must select at least 1
Desired Employment Type
As Needed (PRN)
Full-Time
Locum-Tenens
Part-Time
Seasonal
You must select at least 1
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