Request for Application

Click below to submit a Request for Application* for Medical Staff at the the West Maui Hospital.

*This is not a formal application for Medical Staff at the West Maui Hospital. Formal applications will be forwarded to all interested physicians that meet the Hospital's Medical Staff requirements.

Request for Medical Staff Application

Name:

First Name

Last Name

Address:

Email Address:

Phone #:

(###)

###

####

Years in Practice:

Specialty:

Board Certification:

Board(s) Affiliation

Area of Expertise:

Are you licensed in Hawaii:

If Yes, License #:

Additional information:

WMHMC Site

West Maui Hospital and Medical Center
Kakaalaneo Drive., Lahaina, HI 96761

REQUEST for application

Request for Application

WMHMC Site