Use this form to apply to the Encore Physicians Program. If you wish, you may save a partially-completed form and finish it later. When you are satisfied with all your responses, click the "submit" button at the bottom. When you click "submit" you will be shown a confirmation page where you may review and click "confirm" to finalize your responses. You will also have a "print" option at the bottom of the page. Once you have confirmed the form, you will no longer be able to edit it, and your information will be added to our database for review and consideration. Thank you for your interest in the Encore Physicians Program!