Temporary emergency physician license - COVID-19 health emergency

The forms found throughout this site available for download are listed here for convenience:

Continuing medical education

Address and name change

Initial physician license applications

Physician assistant license/registration applications

Controlled substances certificates registrations

Office based surgery

Laser/other modalities affecting human tissue

Pain Management Services

Collaborative practices

Retired senior volunteer program


Continuing medical education web page

Address and name change web page

  • update address
    1. Log into the Licensee Portal to make address changes - Licensee Portal
    2. Once logged into the Licensee Portal click on the "Update Address" button in the top right corner of the "Address Information" section.
    3. Follow the prompts to make the necessary address changes.
    4. Once the address changes have been made you will be returned to the main screen of the Licensee Portal.
    5. To print a copy of your license or registration scroll to the "License Information" section and click on the printer icon under the "Certificate" column to the right of the license.
  • name change request

Physician license applications web page

Physician assistant license/registration applications web page


Registration Agreement Packet:


Additional skills request:

Controlled substances certificates applications web page

Office based surgery web page

Laser/other modalities  web page

Pain Management Services web page

Collaborative practices web page

Retired Senior Volunteer Program web page



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