Access Request Forms

Non-Credentialed Providers and Affiliated Office Staff


Physicians and Allied Health (Physician Assistants/APRNs) who are not affiliated with BayCare can request access to the BayCare Providers Portal. Download this form to request access.

For additional questions, please contact the Credentials Verification Office (CVO).

Affiliated Office Staff, your sponsoring physician or their assigned delegate will need to log in to the BayCare Providers Portal to request access on your behalf by filling out the Providers Portal Access Request form. The form is available after they log in to the Providers Portal (click here to log in) > Support > Providers Portal Access page.

Note: Non-affiliated provider office staff are not eligible.

For additional questions, please contact the IS Service Desk at 727-467-4700.

For information on BayCare's Health Information Exchange solutions, click here.

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