Form l for texas medical board 2007-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Applicant Section. Fill in your current full name, date of birth, address, and contact information. Ensure that you provide the name of the evaluating hospital and your dates of affiliation.
3. In the Evaluating Physician Section, ensure that a qualified physician completes this part. They must provide their name, title, and evaluation based on personal knowledge or review of credential files.
4. Answer all questions regarding the applicant's reliability, ethics, and character. The evaluating physician should rate various aspects of the applicant’s professional abilities.
5. Complete the Verification of Postgraduate Training section by detailing each training program separately. Include start and end dates along with completion status.
6. Address any unusual circumstances by circling 'Yes' or 'No' as applicable and providing explanations where necessary.
7. Finally, ensure that both you and the evaluating physician sign where indicated before sealing the form in an envelope.

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