Forms
APPLICANT FORMS
- Application Instructions - Applying by Examination (new graduate with no other license)
- Application Instructions - Applying by Endorsement (licensed in another state)
- Report Mailing or Email Address Change
- Report Name Change
- Application for Examination and/or Licensure
- Certificate of Completion (P1E)
- Fingerprint Information and Live Scan Form
- Request for Special Accommodations (D1) & Instructions for Evaluators
- Verification of Clinical Experience for a PTA Equivalency Applicant
- 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.)
LICENSEE FORMS
- Report Mailing or Email Address Change
- Report Name Change
- Request a Verification of License
- 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
MANDATORY REPORTING FORMS
CONSUMER PROTECTION SERVICES 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
