Pre-Application Form
The NVA pre-application process is used to determine if a doctor meets criteria to apply to NVA. Completed pre-application information is reviewed by the NVA Credentialing Committee. In general, only practitioners who answer “Yes” to each of the pre-application questions shall be eligible to apply. If you answer “No” to a question, the NVA Credentialing Committee will consider the information you provide in explanation of the “No” answer and will determine whether your answer provides a compelling reason to grant an exception.
The cost to submit a pre-application is $50. This amount is not refundable. Pre-applications received without payment or incomplete pre-applications shall be returned.
After completing its review, NVA will notify you if you are eligible to submit a full application. You then have sixty (60) days to submit a full application. After sixty (60) days your eligibility will expire and NVA will close your application file.
Respond to each item below. If you answer “NO” to a question or if an explanation of your answer is needed to ensure completeness, please explain why.