Forms

If you require a paper copy of the application please contact the Board office at, [email protected]

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

Dear Applicant:

Please read the following information carefully and completely
Applications may be submitted for a regular license, license by comity (reciprocity) or, license
by universal recognition. Please note the application form contains six (6) pages. All applications
must be completed, signed and submitted with the application/exam fee of $650.00 paid directly
to the Arizona State Board of Podiatry Examiners (“Board”). The application fee includes the
fee to dispense drugs and/or devices. The following supplemental documentation must be
received as part of your application and the accompanying fee.

Supplemental Documentation for New Applicants:

1. Two passport-type photographs of the applicant taken not more than six months before
the date of application. Actual photographs that are passport quality must be submitted.
2. A photocopy of the diploma issued to the applicant upon completion of podiatric school.
3. A photocopy of the residency certificate issued to the applicant upon completion of
residency or a letter from the program director indicating your completion date of the
residency. Please note: The Board cannot accept post-dated certificates as proof of
successful completion of an applicant’s residency;
4. National Practitioner Data Bank self-query report, www.npdb.hrsa.gov
5. Documentation related to any question in which you answered “yes” to any question in
section 11 of the application;
6. A completed “Statement of Citizenship” form and required evidence (must include a
government issued document with a photograph),
https://podiatry.az.gov/forms/statement-citizenship
7. You must possess a valid fingerprint clearance card.
8. The following documents are direct source only documents:
  a. Official transcript(s) from the podiatric medical school(s) attended;
  b. Official transcripts of your examination scores of a national board of examination
      in podiatry; and
  
Supplemental Documentation for Comity Applicants:

1. Two passport-type photographs of the applicant taken not more than six months before
the date of application. Actual photographs that are passport quality must be submitted.
2. A photocopy of a current podiatric license in good standing issued in another state or
jurisdiction;

3. Written documentation of having been engaged in the practice of podiatric medicine for
five (5) of seven (7) years immediately preceding this application.
4. National Practitioner Data Bank self-query report, www.npdb.hrsa.gov
5. Documentation related to any question in which you answered “yes” to any question in
section 11 of the application;
6. A completed “Statement of Citizenship” form and required evidence (must include a
government issued document that has a photo)
7. You must possess a valid fingerprint clearance card.
8. The following documents are direct source only documents:
  a. Official transcripts of your examination scores of a national board of examination
     in podiatry; and
 

Supplemental Documentation for universal recognition Applicants:
1. Two passport-type photographs of the applicant taken not more than six months before
the date of application. Actual photographs that are passport quality must be submitted.
2. Written documentation of having been licensed as a podiatrist in another jurisdiction for
at least one year
3. Documentation verifying that you have established residency in Arizona. Acceptable
documentation may include the following:
  a. A valid Arizona driver’s license
  b. A current Arizona motor vehicle registration
  c. Proof of filing Arizona income taxes in the most recent tax year
  d. Arizona voter registration
  e. Documentation of a mortgage for primary Arizona residence
  f. A dated residential rental contract with proof of payment
  g. Proof of major banking services in Arizona
  h. Proof of establishment of Arizona utilities
  i. Proof of enrollment of children in Arizona schools
  j. Documentation demonstrating a change in permanent address on all pertinent
    records
  k. Military Form 2058
4. National Practitioner Data Bank self-query report, www.npdb.hrsa.gov
5. Documentation related to any question in which you answered “yes” to any question in
section 11 of the application;
6. A completed “Statement of Citizenship” form and required evidence (must include a
government issued document that has a photo)
7. You must possess a valid fingerprint clearance card.
8. The following documents are direct source only documents:
  a) License verification(s) from any other state(s) where licensure is, or has been held.
      The license verification must include the following information:
        • License issuance and expiration date
        • License status (disciplinary action, complaints)

View link:
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.

View file:
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.”

View file:
Change of Address Online

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

View file:
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.

View file:
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.

View file:
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.

View file:
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.

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

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

View file:
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.

View file:
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.

View file:
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. 

View file:
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.

View file:
Volunteer Services Application