The following forms are made available for the convenience of applicants and their FCVS applications.

Please mail the forms listed below to the following address:

		FCVS
		P.O. Box 619850
		Dallas, TX 75261-9850
		  

• Affidavit and Authorization for Release of Information (ALL APPLICANTS) Complete this form and sign it in the presence of a notary. Attach a recent (less than six months) 2" x 2" passport quality color photograph of yourself (alone) to this form in the designated space. Photographs must be clear, front view, full face without a hat or dark glasses. Full length photos, black and white or computer-generated photographs will not be accepted. Sign your name across the front of the photograph. Do not sign on the back of the photograph. Be certain that the notary follows the directions listed on the form.
• Explanation of Alternate Name Form (All Applicants As Necessary) - To explain the use of any name(s) not supported by the identity document(s) submitted with your application. Be certain to sign the form in the space provided at the bottom of the page.
• Explanation of Other Activities During Medical Education Form (All Applicants As Necessary)
• Clinical Clerkship Form (International Graduates ONLY)
• Fifth Pathway Form (International Graduates ONLY)
• Medical School Release Request Form (US, Canadian, & Puerto Rican Graduates ONLY)
• ECFMG Release Forms (International Graduates ONLY)
• NBME Examination History release Form (US, Canadian, & Puerto Rican Graduates ONLY)
• Premedical Education Form (US Undergraduate Programs ONLY)

		FCVS
		P.O. Box 970900
		Dallas, TX 75397-0900
    	  

If you wish to make a change in the recipients designated to receive your Physician Information Profile, please contact our Customer Service Department at 1-888-ASK-FCVS(1-888-275-3287). The agent will email you the correct form.

For your convenience, FedEx Kinko's offers discounted services to FCVS applicants, including photocopies and passport quality photographs. Most of the documentation that you will be requested to send to FCVS can be taken to your local FedEx Kinko's location for one-stop shopping at a greatly reduced cost. Notary services are also available, regular fees apply. Simply present Preferred Customer number 8400051717 at your local FedEx Kinko's location. To find your nearest FedEx Kinko's location, click here.