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Texas Department of Insurance
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Credentialing Forms Listing

If the form is a fillable PDF, learn how to enable all fillable form features.

TDI Form Number Description File Format Language
LHL234

Application Package

PDF English
LHL234a

Other Professional Degrees

Attachment A

PDF English
LHL234b

Other Post-Graduate Education

Attachment B

PDF English
LHL234c

Other Work History

Attachment C

PDF English
LHL234d

Other Current Hospital Affiliations

Attachment D

PDF English
LHL234e

Other Previous Hospital Affiliations

Attachment E

PDF English
LHL234f

Other Practice Locations

Attachment F

PDF English
LHL234g

Malpractice Claims History

Attachment G

PDF English

For more information, contact: MCQA@tdi.texas.gov