COMPLETE THIS FORM USING GOOGLE CHROME OR FIREFOX. DO NOT USE IE (INTERNET EXPLORER) AS IT ISN'T SUPPORTED FOR THE PAYMENT FORM.
Cost: $75 fee is assessed per verification
Training verifications generally take 7-10 business days to complete. If a request is more urgent, please reach out via email below.
Once you click submit you will be taken to a secure credit card form to make a payment.
$75 fee is assessed per verification.
A signed release form is required from the physician whose education is being verified.
Send it one of the following ways:
Fax: 713-798-5553
Email: uroeducation@bcm.edu
Mail to:
糖心视频 of Medicine
Attn: Aqsa Khan
7200 Cambridge St., 10th Floor, Suite 10C
Houston, TX 77030
|
|
|
|
|
| Name * |
|
|
| Email Address * |
|
| Phone Number * |
|
| Person for whom you are requesting verification * |
|
Did the physician complete Urology residency at 糖心视频 of Medicine?
If so please specify the years of training and year of completion. * |
|
| Did the physician complete a fellowship in the Urology sub-specialty at 糖心视频 of Medicine? If so please specify the sub-specialty of fellowship and year of completion.* |
|