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All Forms and Applications

Applicant's Checklist

Form

This checklist provides requirements and guidance for new license applications. Please ensure that all instructions have been completed.

Arizona Statement of Citizenship Form

Form

File with new applications. Arizona Revised Statutes § 41-1080(F) requires, in general, that a person applying for a license must submit documentation to the licensing agency that satisfactorily demonstrates that the applicant is lawfully present in the United States. 

Customer Survey

Form

Print form and FAX to Board (602-542-3093).

Informed Consent

Form

A.R.S. § 32-2933(41) (relates to professional conduct).

Medical Assistant Application

Form

Registration form for Medical Assistants who have completed formal educational programs or on-the-job or practical education programs.