Forms

Application for a Podiatry License

Permanent Licensure
Fillable Forms
For New Licensees

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

View file:
Application for a Podiatry License

Change of Address Online

Fillable Forms
For New Licensees

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.”

View file:
Change of Address Online

Complaint Form

Fillable Forms

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

View file:
Complaint Form

Name Change Request

Fillable Forms
For License Renewal
Other

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

View file:
Name Change Request

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

Permanent Licensure
Fillable Forms
Policy

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.

View file:
Petition for Criminal Convictions and/or Charges Review for State License

Statement of Citizenship

Fillable Forms
For New Licensees
For License Renewal

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

View file:
Statement of Citizenship

Telehealth Registration Application

Forms

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. 

View file:
Telehealth Registration Application

Volunteer Services Application

Volunteer/Temporary Licensure
Fillable Forms
For New Licensees

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.

View file:
Volunteer Services Application