Verification Requests

Submit a verification request using the appropriate form below. Please select the type of verification needed and provide all requested information to help us process your request efficiently. Please allow 5–7 business days for processing.

Employee verification

For organizations requesting verification of current or former employees.

Employee Verification Requests

physician verification

For organizations requesting verification of current or former physicians, medical staff affiliation, credentialing, or related information.

Physician Verification Requests

PHYSICIAN VERIFICATION FORM

Physician Full Name(Required)

Specialty/Department

Requester Name(Required)

First Last

Organization/Facility(Required)

Requester Email(Required)

Requester Phone

Type of Verification(Required)

Comments/ Additional Information

Upload Verification Form

Accepted file types: pdf, doc, docx, Max. file size: 1 GB.

Acknowledgement & Authorization(Required)

I acknowledge and agree to the statement below.

I certify that this request is being submitted for a legitimate credentialing, affiliation, employment, or other professional verification purpose and that I am authorized to request the information identified above. I understand that additional documentation or authorization from the current or former physician may be required before certain information can be released.

EMPLOYEE VERIFICATION FORM

Employee Full Name(Required)
First Last
Employee Status(Required)

Current Employee

Former Employee

Unknown
Approximate Dates of Employment
Requester Name(Required)
First Last
Organization/Company(Required)
Requester Email(Required)

Requester Phone
Type of Verification Requested(Required)
Dates of Employment
Position / Job Title
Employment Status
Department
Other
Additional Information
Authorization / Verification Document
Accepted file types: pdf, doc, docx, Max. file size: 1 GB.

Acknowledgement & Authorization(Required)
I acknowledge and agree to the statement below.
I certify that this request is being submitted for a legitimate employment verification purpose and that I am authorized to request the information identified above. I understand that additional documentation or authorization from the current or former employee may be required before certain information can be released.

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