---
title: Telehealth Nurse Practitioner Application Form Template | Paperform
description: Professional telehealth NP application form with compact license upload, DEA verification, platform proficiency assessment, and malpractice insurance documentation.
url: "https://paperform.co/templates/telehealth-nurse-practitioner-application"
type: static
generatedAt: "2026-03-28T00:45:22.136Z"
---

[← Back to free form templates](/templates/)    ![Telehealth Nurse Practitioner Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/telehealth-nurse-practitioner-application.png)
    [Preview](https://_preview.paperform.co/ai-template/telehealth-nurse-practitioner-application) [Use this template for free](/create?ai-template=telehealth-nurse-practitioner-application)    [Application Forms](/templates/category/applications/) [Staffing & Recruitment](/templates/industry/staffing-recruitment/)[Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/) [HR Manager](/templates/role/hr-manager/)[Recruiter](/templates/role/recruiter/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline Your Telehealth Nurse Practitioner Hiring with Paperform

Finding qualified nurse practitioners for telehealth positions requires careful verification of credentials, multi-state licensing, technical proficiency, and regulatory compliance. This **Telehealth Nurse Practitioner Application** template makes it easy to collect all the essential information you need—from compact state licensure and DEA verification to malpractice insurance and video platform experience—in one professional, secure form.

#### Why This Template Works for Healthcare Organizations

Telehealth has transformed how healthcare is delivered, but hiring for virtual care roles comes with unique requirements. Unlike traditional clinical applications, telehealth positions demand verification of:

 - **Multi-state licensure** through compact agreements
 - **Technical competency** with telehealth platforms and asynchronous care
 - **Prescribing authority** and DEA registration for controlled substances
 - **Professional liability coverage** appropriate for virtual care delivery

This template is designed specifically for **healthcare organizations, telehealth startups, hospital systems, and staffing agencies** that need to efficiently screen and credential nurse practitioners for remote patient care roles. Every field is carefully structured to capture the regulatory and operational details that matter most.

#### Complete Credentialing in One Streamlined Form

Rather than juggling multiple emails, PDFs, and follow-up requests, this template consolidates your entire application process:

 - **Professional background** including NPI number, specialty certifications, and years of telehealth experience
 - **Compact state license verification** with upload capability for documentation
 - **DEA registration details** for prescribing authority verification
 - **Malpractice insurance** documentation with coverage amounts and expiration dates
 - **Platform proficiency assessment** covering major telehealth systems
 - **Asynchronous care capabilities** to understand experience with e-visits and store-and-forward care
 - **Reference information** and availability details

The form uses conditional logic to adapt based on the applicant's licensure status and experience level, making it faster for experienced telehealth NPs while still capturing everything you need from candidates new to virtual care.

#### Secure File Collection and Compliance-Ready Documentation

Healthcare credentialing requires secure handling of sensitive professional documentation. This template includes dedicated file upload fields for:

 - Compact state nursing license (or multi-state authorization)
 - DEA certificate
 - Malpractice insurance certificate
 - Board certification
 - Resume/CV

All file submissions are securely stored within Paperform, with **SOC 2 Type II compliance** ensuring your applicant data meets healthcare industry security standards. While Paperform is not HIPAA-compliant for patient data, this application form collects professional credentialing information that falls outside PHI requirements.

#### Automate Your Credentialing Workflow with Stepper

Once applications are submitted, you can use **[Stepper](https://stepper.io)**—Paperform's AI-native workflow automation tool—to streamline your credentialing process:

 - Automatically route applications to your credentialing team via email or Slack
 - Create applicant profiles in your ATS or HRIS (like BambooHR or Greenhouse)
 - Trigger background check and license verification processes
 - Send personalized follow-up emails based on applicant qualifications
 - Update hiring status in your CRM or project management system

This automation eliminates manual data entry and ensures every qualified candidate moves smoothly through your credentialing pipeline, helping you fill critical telehealth positions faster.

#### Built for Healthcare Recruiters and Telehealth Leaders

This template is ideal for:

 - **Telehealth companies** building distributed clinical teams
 - **Healthcare staffing agencies** specializing in virtual care placements
 - **Hospital systems** expanding telemedicine services
 - **Healthcare startups** launching direct-to-consumer telehealth platforms
 - **Multi-state group practices** requiring compact licensure
 - **Healthcare HR teams** managing credentialing for remote providers

The form's professional design and comprehensive question set demonstrates your organization's commitment to quality and compliance—helping you attract top-tier nurse practitioner talent.

#### Customizable and On-Brand

While this template includes all the standard fields for telehealth NP credentialing, you can easily customize it to match your specific requirements:

 - Add organization-specific questions about your patient population or clinical protocols
 - Include fields for additional certifications (ANCC, AANP, specialty credentials)
 - Modify the platform proficiency section to match your technology stack
 - Adjust availability questions for your scheduling needs
 - Update the theme to match your healthcare brand

Paperform's doc-style editor makes customization simple—just type, format, and rearrange as needed.

#### Get Started in Minutes

Whether you're hiring your first telehealth NP or building out an entire virtual care team, this template gives you a professional, compliance-ready application process from day one. Collect all the credentials you need, automate your follow-up with Stepper, and make better hiring decisions faster.

Start using this Telehealth Nurse Practitioner Application template today and transform your healthcare recruiting process.
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