Forms

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 (A.R.S. 32-4302). The universal recognition policy allows Arizona residents to use an out-of-state 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

Pursuant to section 32-4302, Arizona Revised Statutes, a person shall be granted an occupational or professional license or certificate if the person has been licensed or certified in another state for at least twelve months, the license or certificate is in the same discipline and at the same practice level as the license or certificate for which the person is applying in this state and the person meets other conditions prescribed by section 32-4302, Arizona Revised Statutes.

Active Duty Service Members, Military Spouses and Veterans please see the below links:

A.R.S. 32-4302

A.R.S. 32-4303

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Application for a Podiatry License

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.

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Application for a Temporary Podiatry License

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.”

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Change of Address Online

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

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Complaint Form

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.

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Initial Registration to Dispense Drugs and Devices Form

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.

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License Verification (for verifying out of state licenses)

Pdf fillable document to allow for an Arizona podiatrist to request new wall and wallet licenses due to a name change.

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Name Change Request

Pursuant to A.R.S. § 41-1093.04 a person with a criminal record may petition the Arizona State Board of Podiatry Examiners (Board) prior to submitting an application for licensure for a determination of whether the person’s criminal history disqualifies the person from obtaining a license.

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Petition for Criminal Convictions and/or Charges Review for State License

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

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Public Records Request

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

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Replacement / Duplicate License

Online form for a person applying for a license, to satisfactorily demonstrating that he/she is lawfully present in the United States.

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Statement of Citizenship

Pursuant to A.R.S. 36-3606 an individual who is licensed in another jurisdiction can apply to provide telehealth services in Arizona. Please see the application for exemptions from being required to register to provide telehealth services in Arizona. 

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Telehealth Registration Application

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.

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Volunteer Services Application