Urology Education Verifacation

Online Payment

Pay Online
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


Verifications generally take 7-10 business days to complete. At this time, no urgent requests can be processed.

Payment may be sent by check along with a signed release from the physician whose education is being verified.

Once you click submit you will be taken to a secure credit card form to make a payment. You will be asked to fill in the payment amount. Payment can also be assessed by check to the address below.

$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:

Baylor College of Medicine Attn: Sarah Goudeau/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 you complete residency at Baylor College of Medicine?
If so please specify the year of completion. *
Did you complete a fellowship at Baylor College of Medicine? If so please specify the type of fellowship and year of completion.*