Forms
APPLICANT FORMS
- Request for Address Change
- Request for Name Change
- Application for Examination and/or Licensure
- Certificate of Completion (P1E)
- Verification of Clinical Experience for a PTA Equivalency Applicant
- Request for Special Accommodations (D1) & Instruction for Evaluators
- Fingerprint Information & Live Scan Form
- Approved Credential Evaluation Services
- Notice of Intent to Supervise a Foreign Educated Physical Therapist (NOI) Form
- Work Verification Form for a Foreign Educated Applicant - Period of Clinical Service (Only for those applicants that are already licensed in another State in the U.S.)
- Sponsored Free Health Care - Sponsoring Entity Registration Form
- Request for Authorization to Practice Without a California License at a Sponsored Free Health Care Event
LICENSEE FORMS
- Request for Address Change
- Request for Name Change
- Request for Endorsement
- Request for Duplicate Certificate
- Request for Retired License Status
- License Renewal - Criminal Conviction Disclosure Requirements
- Criminal Conviction Questionnaire
- Statement of Renewal
- Form NTC 12-01, August 2, 2012 – Notice to Consumers
- Spanish Translation
- Tagalog Translation
- Hindi Translation
- Russian Translation
- Simplified Chinese Translation
CONTINUING COMPETENCY
- Continuing Competency Disclosure Questionnaire
- Inactive to Active License Status Application
- Continuing Competency Activities and Coursework Checklist
- Continuing Competency Exemption Application
CONSUMER PROTECTION FORMS
- Consumer Complaint Form
- Authorization of Patient Health Information
- For additional information on How to File a Complaint, please click here.
- How to Become an Expert Consultant/Practice Monitor for the Board
- Expert Consultant/Practice Monitor Selection Criteria
- Expert Consultant/Practice Monitor Application
PETITION FOR PENALTY RELIEF REINSTATEMENT OF LICENSE/MODIFICATION AND⁄OR TERMINATION OF PROBATION
- Instructions for Preparing Petition Application
- Business & Professions Code 2661.7 Petition for Modification
- Petition for Reduction of Penalty Application
