Non-renewal request

If you do not desire to renew your license for next year, please send to the following information:

  • Licensee name and number
  • Contact email address and telephone number in case there are questions
  • Which license type to make inactive:
    • primary license (MD, DO, L, RSV, SP) - will also change the status of active ACSC
    • ACSC/QACSC license only
    • PA/AA license - will also change the status of active QACSC

By submitting this request you acknowledge that you agree and understand that you are requesting the status of your license to be changed from ACTIVE to ACTIVE - NON RENEWAL BY REQUEST. With this status the licensee will not receive any renewal notices and after annual renewals the license status will become INACTIVE.

If at a later time you decided you want the license returned to Active status you will have to reinstate the license. Click Here for more information on reinstatement.

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