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Order Reports

Select Who You Are Below:

Podiatrist YOU are, or represent, a PODIATRIST and want to order a report to be sent to a destination. Organization YOU represent an ORGANIZATION (ex: hospital, CVO) and want to order a report on a podiatrist to be sent to your organization.
Order Reports - Podiatrists
Podiatrists can request that the Federation of Podiatric Medical Boards send their Part I/II/III (PMLexis) Score and/or Disciplinary reports to State Boards, Residencies, Fellowships, VAs, etc. only.
Reports cannot be sent to individuals. After completing the form, you will have the option to pay online by credit card -or- print out a form to mail in with a check.

(No User Account Required)
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Order Reports - Organizations
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FPMB Disciplinary Reports
are FAST and EASY to Order
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Online Ordering
  • Available 24/7/365
  • FPMB processes most reports within 1 business day
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Electronic Delivery
  • Reports are sent electronically
  • Reports are in PDF format
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First-Class Support
  • Friendly, knowledgeable support available via phone & email
  • Results-focused assistance to meet your needs
Organizations must have an online account to place orders. To create an account, please download, complete and return the Website User Account Request Form.
Organizations(managed care, CVOs, etc.) can request that the Federation of Podiatric Medical Boards send Disciplinary reports on podiatrists via our fast, secure and convenient online system. After completing the form, you will have the option to pay online by credit card -or- print out a form to mail in with a check. Processed reports are returned to organizations via secure electronic delivery.
Frequently Asked Questions
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Order Reports - Organizations

Contact Information

Please verify that all contact and address information below is accurate. If any of this information is incorrect, do not proceed with this order and contact the FPMB at fpmb@fpmb.org.
ELECTRONIC DELIVERY
(for email notification to download completed reports)
Name
Title
Email Address
BILLING INFORMATION
(if paying by credit card; receipt is sent to this email address)
Name
Company
Address
City/State/ZIP Code
Phone Number
Email Address
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Order Information

Indicates a Required Field
How many PROVIDERS are in this order? REQUIRED: How many PROVIDERS are in this order?

PROVIDER #1:
FIRST Name REQUIRED: First Name #1
Middle Name
LAST Name REQUIRED: Last Name #1
Maiden/Alternate Name
Date of Birth REQUIRED: Date of Birth #1 INVALID: Date of Birth #1 [format: 1/1/1950] (format: 1/1/1950)
Social Security Number REQUIRED: Social Security Number #1 INVALID: Social Security Number #1 [format: 123-45-6789] (format: 123-45-6789)
PROVIDER #2:
FIRST Name REQUIRED: First Name #2
Middle Name
LAST Name REQUIRED: Last Name #2
Maiden/Alternate Name
Date of Birth REQUIRED: Date of Birth #2 INVALID: Date of Birth #2 [format: 1/1/1950] (format: 1/1/1950)
Social Security Number REQUIRED: Social Security Number #2 INVALID: Social Security Number #2 [format: 123-45-6789] (format: 123-45-6789)
PROVIDER #3:
FIRST Name REQUIRED: First Name #3
Middle Name
LAST Name REQUIRED: Last Name #3
Maiden/Alternate Name
Date of Birth REQUIRED: Date of Birth #3 INVALID: Date of Birth #3 [format: 1/1/1950] (format: 1/1/1950)
Social Security Number REQUIRED: Social Security Number #3 INVALID: Social Security Number #3 [format: 123-45-6789] (format: 123-45-6789)
PROVIDER #4:
FIRST Name REQUIRED: First Name #4
Middle Name
LAST Name REQUIRED: Last Name #4
Maiden/Alternate Name
Date of Birth REQUIRED: Date of Birth #4 INVALID: Date of Birth #4 [format: 1/1/1950] (format: 1/1/1950)
Social Security Number REQUIRED: Social Security Number #4 INVALID: Social Security Number #4 [format: 123-45-6789] (format: 123-45-6789)
PROVIDER #5:
FIRST Name REQUIRED: First Name #5
Middle Name
LAST Name REQUIRED: Last Name #5
Maiden/Alternate Name
Date of Birth REQUIRED: Date of Birth #5 INVALID: Date of Birth #5 [format: 1/1/1950] (format: 1/1/1950)
Social Security Number REQUIRED: Social Security Number #5 INVALID: Social Security Number #5 [format: 123-45-6789] (format: 123-45-6789)
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Review and Place Order

INSTRUCTIONS
10/4/2024 7:25 PM ET
  1. Print a copy of this order by clicking the "PRINT ORDER" button below.
  2. Make check payable to the "Federation of Podiatric Medical Boards" for the TOTAL amount displayed below.
  3. Send the check and a copy of this request to:
Federation of Podiatric Medical Boards
12116 Flag Harbor Drive
Germantown, MD 20874-1979
Do not send by Registered, Certified or Express Mail -- this will delay processing your request.
**You will receive an email notification when your order has been processed.**
Please allow up to ten (10) business days from the date that payment is received for your order to be processed.
PAYMENT STATUS: ACCEPTED
10/4/2024 7:25 PM ET
Print a copy of this order as a receipt by clicking the "PRINT ORDER" button below.
**You will receive an email notification when your order has been processed.**
Please allow up to ten (10) business days for your order to be processed.
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FPMB Disciplinary Reports
are FAST and EASY to Order
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shopping_cart
Online Ordering
speed
Electronic Delivery
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First-Class Support
NAME
TITLE
Phone Number
Email Address (for delivery)
ORDER ID
Provider 1
Provider 2
Provider 3
Provider 4
Provider 5
TOTAL
ALL ORDERS ARE FINAL. NO REFUNDS WILL BE PROVIDED.
INSTRUCTIONS
  1. In the Order Summary section, verify the Order Amount and Description.
  2. In the Credit Card Information section, enter your credit card (Visa or MasterCard) information.
  3. In the Billing Information, verify that your name and contact information are correct.
  4. Click the Process Payment button.
NOTE: To pay by check, click the Review Order button below.
ALL ORDERS ARE FINAL. NO REFUNDS WILL BE PROVIDED.
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We are sorry, but your payment was declined for the following reason:
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INSTRUCTIONS
  1. If you have a problem with one credit card, you may wish to try a different card.
  2. Click the "Credit Card (try again)" button below to try again.
  3. To pay by check, click the "Pay By Check" button below.
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Pay by
Check
(print & mail)
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Pay by
Credit Card
(try again)
Order Reports - Podiatrists
Federation of Podiatric Medical Boards
12116 Flag Harbor Drive
Germantown, MD 20874-1979
Phone: 202-810-3762
Fax: 202-318-0091
Email: fpmb@fpmb.org
Copyright 2024 by Federation of Podiatric Medical Boards
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