Please provide names and complete addresses of four (4) professional references. At least 3 need to be peer.

• These individuals must have personal knowledge, over the most recent two year period, of your current clinical skill, ability, ethical character, judgement, professional performance, and clinical competence or have been responsible for professional observation of your work.
• References should not be provided by relatives, current classmates, spouse or domestic partner.
• Acceptable references include referring providers or professional peers - defined as being in the same professional discipline with equal qualifications.
• References should be individuals other than your business partners or associates, if possible.