Provider
Interest Form

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While we are always looking to add qualified providers to our team, submitting your information is not an official application for a position. Once we have received your submission, you will be scheduled for an initial interview where we can get to know you and answer your questions.

Our clinical needs change on a daily basis. There could be an immediate opening that would be a great fit, or you will be placed on our list to contact when a match is available.

    I am a looking for a







    What is your ideal work environment?*

    InpatientOutpatientResidentialIntegrated Care

    Preferred age range of patients?*

    AdultAdolescentChildGeriatrics

    Specialty*

    AdultChild/AdolescentGeriatricsConsult LiaisonForensicsAddictionsMAT WaiverPostpartum DepressionLifespan

    State Licenses?*

    Puerto RicoAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

    Inactive Licenses?

    Puerto RicoAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

    How did you hear about innovaTel?

    Interested in providing MAT services?

    YesNo

    How many years have you been prescribing buprenorphine?

    How many patients (approx.) per month are you treating with buprenorphine?

    Almost Done!
    Upload your CV and submit

    Upload your CV (PDF or Word Doc)*