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Your FREE consultation is kept completely confidential & will be provided for you to determine the following:

  • Licensing Cost
  • Time-frame
  • Eligibility Requirements
  • Dynamic Requirements

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In which state(s) are you interested?*
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Your Name

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Comments:

Country of Medical Education:

Years of Post Graduate Training (in the same specialty):

Attempts on Exams: (USMLE, NBME, etc.):
List exams & years, such as "USMLE-1999, NBME-2003"

Have you been board certified/re-certified in the last 10 years?

Have you had clinical contact in the last 2 years?


Do you have an established FCVS profile?

Please provide a phone number if you answer “yes” to the following questions:

Have you been named in a malpractice claim?
Have you been subject to disciplinary action during training or education?

Have you had any licenses disciplined?
Have you had any hospital privileges disciplined?
Convicted of any misdemeanors or felonies? (not to include minor traffic infractions)
Alcohol or substance abuse?
Treated for depression?
Any condition which would prevent you from practicing medicine with reasonable skill and safety?

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