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GME Primary Source Training Verification
Step 1: Training Program
Step 2: Physician Info
Step 3: Service Type
Step 4: Requestor Info
Step 5: Finish
Step 1: Select Training Program
State
Specialty
Program
If a program is not listed, they have not yet
signed up
for this app.
Step 2: Enter Physician's Information
First Name
Last Name
Other names used
Any other names used by the physician must be listed on the release form
Training Start Date
End Date
End date must be valid and after start date
Release Form
Upload Release Form
You must upload a release form that is less than 10MB
Step 3: Select Service Type
Verification Form Type
VGMET
(
)
Your Custom Form (
)
Choose file to upload
Required
Service Speed
Standard Service (~ 10 Business Days,
)
Expedited Service ( 3 Business Days,
)
Delivery method
Download
Physical copy by mail
Fax copy
Step 4: Provide Your Information
Name/Title/Company
Your e-mail address
Confirm e-mail
Please enter a valid email address.
e-mail confirmation did not match previous email.
Order confirmation emails and receipts will be sent to this address ⬆️. If you need the completed form copied elsewhere, enter that email address below.
cc email(s)
Phone
Street Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
NE
NH
NJ
NM
NV
NY
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Zip
Fax number
Special instructions
Step 5: Confirmation & Payment
Acknowledge:
Payment is non-refundable, even if training cannot be verified
(expedited fee is refundable if service cannot be expedited)
Service time does not include mailing time
I agree to the complete
terms and conditions
Total cost: