Urology Education Verification

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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:

Baylor College 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 Baylor College 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 Baylor College of Medicine? If so please specify the sub-specialty of fellowship and year of completion.*