Request a verification

    Please complete this form and an ETM Representative will contact you.
    Typical turnaround time is three business days.

    Verification Type *

     
    Provider’s Signed Release (pdf, doc, docx) *

    Employment Verification Request Form (if Employment Verification is selected) (pdf, doc, docx) *

     


    Contact information

    Address:
    280 Interstate North Circle, SE
    Suite 600, Atlanta, GA 30339

    Phone:
    800.369.4603

    Email:
    info@eagletelemed.com

    Social links:

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