Arizona Medical Board
Patricia McSorley, Executive Director
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  • Find your MD/Resident/Temp License
  • Licensure
  • Regulation
  • For Consumers
  • Laws & Rules
  • MD Center
  • Forms
  • Licensure Compact
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Forms
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Forms List

Adjudication Process Document AMB
Guidelines for CAM
The Arizona Medical Board's Guidelines for Physicians Who Incorporate or Use Complementary or Alternative Medicine in Their Practice.
AMB IMLCC Approval Notice Supplemental Forms
Application Fee Waiver Fillable Form
provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Medical Doctor, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents
Application Fee Waiver Instructions
Instructions for the Application Fee Waiver Form
Application Fee Waiver Static Form
provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Medical Doctor, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents.
Citizenship Statement
This form is to be completed by the applicant and is to be submitted for every application, permit or registration that is offered by the Arizona Medical Board, with the exception of the renewal of license if citizenship has previously been established with the Board.
Clinical Instructor Verification Form
CME Audit Form
Combined CME Table effective 12-28-2017
Complaint and Investigation Process Summary
Data Disk Order Form
To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions|(Providing an electronic medium containing public information about licensed physicians: $100.00*)
Dispensing Registration Application
Evidence List - as referenced for the full MD license application
As a requirement for licensure in Arizona, United States citizens must provide a notarized copy of their birth certificate or notarized copy of their passport in accordance with A.A.C. R4-16-201(C)(1). Non-citizens must provide proof of immigration status in accordance with A.R.S. § 41-1080 (see Evidence List) in addition to a notarized copy of their birth certificate or passport, A.A.C. R4-16-201(C)(1).
Jury Duty Medical Excuse Form
Should a patient requests that they be excused from jury service for reasons related to mental or physical conditions
License Verification Request Form
(Verifying a license: $10.00 per request*)
Locum Tenens Application
MD Complaint
MD Duplicate License Form
MD Resident List
MD Temporary License Application
MD Temporary License List
Medical Directory Download
Downloadable Physician and Physician Assistant Directory
Medical Directory Order Form
(Providing a copy of annual allopathic medical directory: $30.00*) Use this form to request a Physician and Physician Assistant Directory
Misc. Evidence List
Model Policy Guidelines for Opioid Addiction Treatment in the Medical Office
Moral Turpitude
<span>Misdemeanor offenses that have been determined to affect patient safety and are reportable under A.R.S. &sect; 32-3208 by a licensee or license applicant.</span><br /> <br /> <span>Other misdemeanors reportable under A.R.S. &sect; 32-3208 besides those specifically listed within this document include any comparable charges filed against an Arizona licensee or license applicant by any other state, territory or country.</span>
Name Change Form
Notice of Exempt Final Rulemaking Article 2 Licensure
Notice to Patients Form
"A.R.S. 32-1401(26)(ff) requires that a physician notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician is referring the patient." The statute requires that a physician use this Board prescribed form.
Office Based Surgery Rule Clarification
Online Application Checklist and Required Supplemental Forms
Postgraduate Training Permit Registration
Printable Initial Application
MD Paper Renewal
Use the MD Paper Renewal Form if you would like to print and mail your application. Please allow 4-6 weeks for the processing of paper renewals.
Pro Bono Reapplication
Pro Bono Application
Public Information Request Form
To request public information, download this printable form which includes detailed instructions|(Providing a copy of records, doucuments, letters, minutes, applications, and files, $1.00 for the first three pages and $0.25 for each additional page*)
Reactivation Application
Note: This application may only be utilized if your license status is currently ‘Inactive’. You may not use this application if your license is currently Expired or Cancelled.
Reference for Physicians on the Use of Opioid Analgesics in the Treatment of Chronic Pain in the Office Setting
Reportable Misdemeanors
Misdemeanor offenses that have been determined to affect patient safety and are reportable under A.R.S. § 32-3208 by a licensee or license applicant. Other misdemeanors reportable under A.R.S. § 32-3208 besides those specifically listed within this document include any comparable charges filed against an Arizona licensee or license applicant by any other state, territory or country.
Request For Inactivation Or Cancellation
Prior to submitting your request please read the following statutes regarding the qualifications of Inactivation or Cancelation of your Arizona medical license.
Scope of Practice Guidelines
Arizona Medical Board Scope of Practice Guidelines
Teaching License Application
Teaching License Reapplication
Temporary License Language
The Board's Complaint Process

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   Address:   1740 W Adams St, Suite 4000
Phoenix, AZ 85007
   Hours:   8am - 5pm Mon - Fri
   Phone:   (480) 551-2700
   Toll Free:   (877) 255-2212
   Fax:   (480) 551-2702
   Email:   Contact the Board
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