Verification request form sample 2026

1. Click ‘Get Form’ to open the verification request form in the editor.
2. Begin by entering your Name and Date of Birth in the designated fields. Ensure that these details are accurate for proper identification.
3. Fill in the Address where you would like the document sent, along with your Email address and Phone number for any follow-up communication.
4. If you have an ABR ID number, enter it in the provided field. This helps streamline your request.
5. Indicate whether the verification letter is for state licensing/permit purposes by selecting 'Yes' or 'No'. If 'Yes', specify if previous exam results should be included.
6. For payment, choose your preferred method (Check, VISA, MasterCard, American Express) and fill out the necessary credit card information if applicable.
7. Review all entered information for accuracy before submitting. Once confirmed, mail or fax the completed form to The American Board of Radiology as instructed.

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