Nominate a Provider

If you would like to nominate a provider or fitness facility to join American Specialty Health Group (ASH Group) or American Specialty Health Fitness (ASH Fitness) please complete the information below. All nominated providers or fitness facilities are sent credentialing or application materials and invited to join ASH Group or ASH Fitness. Once the completed materials are received, the process will take approximately 60-90 days to complete. If a provider or facility is approved to participate, ASH Group or ASH Fitness will notify them with welcome materials and specific information regarding participation. Providers/facilities that are approved for network participation are activated immediately once credentialing is completed.

Provider Information
Name:
May we share your name with the provider?

*ChooseHealthy will only share your name with the provider if you give us authorization to do so. View our Privacy & Security policy.

Providers First Name:*
Providers Last Name:*
Clinic/Facility Name:
Provider Specialty:*
Phone:*
(###-###-####)

Provider Address
Street:*
City:*
State:*
Zip Code:*