Tellus Wellness Provider Application

Welcome to our process in completing your application to be part of the Tellus Wellness network. This application is for new providers with organizations that are already contracted with Tellus Wellness. If your organization does not have an existing contract with Tellus Wellness, please use this application.

Please See an Important Welcome Message from our Chief Medical Officer

By submitting this bio/statement, you authorize Tellus Wellness to utilize the content for the provider directory and other Tellus Wellness marketing purposes.

We recommend that your most important information be detailed first, given that the information will be truncated due to screen display restrictions.

Tellus Wellness reserves the right to edit any language deemed offensive or inappropriate for the Tellus Wellness website.

A copy of our Provider Agreement and Fee Schedule can be found here.

NOTE: electronic documents you'll need to upload as part of the application process:

• Provider License File

• Malpractice Insurance Certificate

• Personal photo (headshot)

• Vitae/Resume

This application takes approximately 30 minutes to complete. You will have the option to save and come back at a later time if needed.

If you are completing this application for an organization with multiple providers -- it will need to be completed for each provider.

We look forward to working with you.

Questions? Send us an email: support@telluswellness.com