Credential Verification Agreement

By submitting this registration, I certify that all information provided is true, accurate, and complete. I understand that misrepresentation may result in termination and/or reporting to the appropriate licensing authority.

I authorize this organization to verify my credentials with issuing authorities including state medical boards, certifying bodies, and the NPDB.

I acknowledge it is my sole responsibility to maintain current, valid licensure and to provide updated documentation prior to expiration.

I consent to the storage and processing of my information for credential verification purposes.