Before an application can be released, you must first complete a Request for Application.

1. Download and print the Request for Application form for Memorial Hermann hospitals, affiliate hospitals and surgery centers, and MHMD membership.
2. Upload the completed and signed form to your device and email it to [email protected].
3. Requests are processed in 1-2 business days. After your request has been processed you will receive an initial pre-screening call from a member of MHMD’s Network Management team.
4. After the pre-screening qualifications are met, you will receive your eCredentialing Portal & Application username and password via email.

Learn more about the reappointment process.

Questions?

Please reach out to MHMD’s Credentialing Department by email, phone or fax.
Email | [email protected]
Phone number | 713.338.6464, select option 3, and then select option 3
Fax number | 713.338.6964