Use this form to request verifications for trainees who completed training before Jan. 1, 2013, as well as requests for completing state licensing board forms for ALL training timeframes, at Mayo Clinic School of Graduate Medical Education in Phoenix/Scottsdale, Arizona; Jacksonville, Florida; or Rochester, Minnesota.
We can provide these types of verifications:
- Postgraduate training
- Malpractice claims history
- Professional malpractice insurance coverage (certificate of insurance)
- State licensing board forms (for all training time frames; see additional section below for forms to be uploaded)
Complete all required fields below and include a scanned copy of a signed authorization of release form.
- Trainees requesting verifications on their own behalf should use this authorization form.
- Credentialing institutions should use their own release form that has been signed by the trainee within the last year.
Requests will not be processed without a current release of information form uploaded.
You will see a confirmation message after submitting this form. Requests can take up to three weeks to process. Please refrain from submitting additional requests or emails for updates, as this can delay our work. If you have any questions, contact firstname.lastname@example.org.
Need something else? Review our Contact and Verifications page for details about requesting verifications for residency or fellowship training completed after Jan. 1, 2013, as well as other types of verifications.