All Forms and Applications | Homeopathic and Integrated Medicine Examiners

Applicant's Checklist

Form

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

Application for Homeopathic Physician

Form

Application for license as a homeopathic physician.

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.

Continuing Education Application

Form

Apply for approval of CME.

Customer Survey

Form

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

Dispensing Permit

Form

For new applications, or renewal.

Homeopathic Physician Renewal Form

Form

Application for renewal of license for a Homeopathic Physician

Fill this Renewal form out and pay for it ONLINE by clicking below

Online Renewal Form and Payment

Homeopathic Practitioner Initial Application

Form

Informed Consent

Form

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

Initial Licensing Information

Form

This information packet explains the requirements for licensure.

List of Misdemeanor/Felony Violations

Form

Reportable by Law A.R.S. §32-3208.

Medical Assistant Application

Form

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

Medical Assistant Application Form III

Form

Registration form for Medical Assistants who have held or currently hold another health care license, certificate, or registration.

Medical Assistant Renewal Application

Form

Public Records Request Form

Form

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

For questions about Public Records Requests contact:

Richard Graham
602-542-8154
[email protected]