Board of Podiatry Examiners
State of Arizona

All Forms and Applications

2018 License Renewal form

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PDF fillable document to provide an active Arizona podiatrist to renew his/her podiatry license and registration to dispense. 

Application for a Podiatry License

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Pdf fillable document to provide for the ability to be licensed as a podiatrist in the State of Arizona. 

Change of Address Online

Online Form

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

Online Form

Online document to allow anyone the ability to file a complaint against a current Arizona podiatrist. 

Initial Registration to Dispense Drugs and Devices Form

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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)

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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

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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

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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.

Public Records Request

Online Form

Online document to allow anyone to request copies of public records.

Replacement / Duplicate License

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Pdf fillable document to allow for an Arizona podiatrist to request multiple licenses for multiple offices or replace a lost or misplaced license.

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

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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.