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NHSC Publications: Private Practice Assignment (PPA) and Private Practice Option (PPO) agreements

Sample Agreements

These are sample agreements that may be used as reference only. Once you have been employed at an approved site, NHSC will complete the form and send to clinician. All other copies are considered void.


  • Private Practice Option Application (Acrobat)
    This PPO application initiates a request for a NHSC clinician to open their own private practice or one who is interested in working at an existing private practice. Just by submitting a PPO application does not allow a physician to be approved for the private practice option. Approvals of all PPO applications will be sent in writing from the In-Service Support Branch. In addition to filling out the PPO application, additional documentation will be required. See documentation requirements for private practice options.

Adobe Acrobat is available for free download from the Adobe site.

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Health Resources and Services Administration U.S. Department of Health and Human Services