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MISSION STATEMENT The Goal of Texas Tech University 2026

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The document is a Practice Log Verification Statement from the American Board of Urology, requiring candidates to provide personal and professional information, including their medical school, residency training, areas of special focus, fellowship details, and a brief description of their current practice. It emphasizes the importance of accurate log submissions for office visits and surgical procedures, with a notarized signature required to confirm the authenticity of the information provided.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the designated field at the top of the form. This personalizes your submission and ensures proper identification.
Next, fill in your medical school information. This section is crucial for establishing your educational background.
Indicate your Urology Residency Training Program by providing the relevant details. This helps in verifying your training credentials.
Select any area of special focus in your practice from the provided options. Make sure to check only one box that best represents your specialty.
If applicable, describe any fellowship training you have completed, including subspecialty area, location, and dates.
In 100 words or less, summarize your current practice. This section allows you to highlight key aspects of your professional experience.
Finally, ensure you sign the document where indicated and provide necessary contact information. Remember that a notarized signature is required for validation.

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