All Forms and Applications

2019 License Renewal form Download Form (238.9 KB)	PDF fillable document to provide an active Arizona podiatrist to renew his/her podiatry license and registration to dispense.
Application for a Podiatry License Download Form (659.09 KB)	Pdf fillable document to provide for the ability to be licensed as a podiatrist in the State of Arizona. Licensure by Universal Recognition On August 27, 2019, the Arizona Board of Podiatry Examiners will begin accepting applications for licensure by universal recognition. The universal recognition policy allows Arizona residents to use an out-of-stat professional or occupational license qualify for an Arizona license to work. To qualify, an applicant must: Prove residency in Arizona Be currently licensed or certified for at least one year in another U.S. state in the discipline applied for and at the same level of practice as recognized in Arizona. Be in good standing in all states where currently or previously licensed or certified. Have met all applicable education, work, exam, and/or clinical supervision requirements in the other state where originally licensed or certified. Complete a criminal background check when required by law. Take and pass any applicable exam on Arizona state law. Pay all applicable licensing fees
Change of Address Online Download Form (247.14 KB)	Online form to allow for an applicant or licensed podiatrist the ability to update business and/or residential address(es). Pursuant to A.R.S. § 32-829(D), “each licensee shall promptly and in writing inform the board of the licensee’s current office address and of each change in office address within thirty days.”
Complaint Form Download Form (71.55 KB)	Online document to allow anyone the ability to file a complaint against a current Arizona podiatrist.
Initial Registration to Dispense Drugs and Devices Form Download Form (87.31 KB)	Pdf fillable document to provide for the ability of a licensed Arizona podiatrist to dispense drugs/devices controlled within their possession, including DME, orthotics, topicals, etc.
License Verification (for verifying out of state licenses) Download Form (83.93 KB)	Pdf fillable document to allow an applicant the ability to verify out-of-state podiatric licenses currently or previously held. Please note: each jurisdiction may require a nominal fee and that fee must be submitted along with this form.
Name Change Request Download Form (75.16 KB)	Pdf fillable document to allow for an Arizona podiatrist to request new wall and wallet licenses due to a name change.
News Release - Scope of Practice Download Form (129.15 KB)	Beginning August 8, 2017, the statutes excluding amputations, in Arizona, will change to allow for partial amputations that will not include the leg or entire foot.
Ombudsman Download Form (112.61 KB)
Public Records Request Download Form (79.21 KB)	Online document to allow anyone to request copies of public records.
Replacement / Duplicate License Download Form (74.13 KB)	Pdf fillable document to allow for an Arizona podiatrist to request multiple licenses for multiple offices or replace a lost or misplaced license.
Small Business Bill of Rights Download Form (231.86 KB)
Statement of Citizenship Online Form	Online form for a person applying for a license, to satisfactorily demonstrating that he/she is lawfully present in the United States.
Volunteer Services Application/Application for a Temporary Podiatry License Download Form (158.85 KB), Download Form (168.91 KB)	Pursuant to A.R.S. § 32-3217, a podiatrist, who is not licensed to practice in the state of Arizona, may apply for a volunteer health services registration for up to 14 days, each calendar year if he/she meets certain criteria. Pursuant to A.R.S. §32-3124, a podiatrist, who is not licensed to practice in the state of Arizona, may apply for a temporary license if he/she meets certain criteria.