Credit Card Payment MD Duplicate License
To pay for a duplicate license by credit card
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Credit Card Payment MD Duplicate Wallet Card
To pay for a duplicate wallet card by credit card
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Physician Complaint Form
To file a complaint against an M.D. licensed in Arizona, download this printable form which includes detailed instructions
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Physician Assistant Complaint Form
To file a complaint against an P.A. licensed in Arizona, download this printable form which includes detailed instructions
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Public Information Request Form
To request public information, download this printable form which includes detailed instructions
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License Renewal Form
Please allow 30 days for the processing of paper renewals. If you need your wallet card prior to then, please use the online renewal system.
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License Verification Request Form
To request that a license verification (sometimes called a letter of good standing) be sent to another board or organization
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Jury Duty Medical Excuse Form
Should a patient requests that they be excused from jury service for reasons related to mental or physical conditions
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Data Disk Order Form
To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions
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Medical Directory Order Form
To request a Physician and Physician Assistant Directory via website download or via printable request form
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Change of Address Form
Licensees must notify the Board in writing within thirty (30) days of any address changes
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Legal Name Change Form
To notify the Board of a legal name change, download this printable form.
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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
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Termination of Supervision
To terminate (end) supervision of a Physician Assistant, download this printable form to complete and return to the board
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The Arizona Medical Board uses Adobe Acrobat for the distribution of electronic versions of its documents.
You must have the free Adobe Acrobat Reader installed on your computer to view these files.
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Arizona Medical Board