Third Party Verification

DO NOT USE this form if you have ever been a licensed PT/PTA in Arizona.  If a previous or current AZ licensee requires a verification sent directly from the Board, they must log into their Licensee Portal to to submit and pay for a Document Request. NOTE: licensees may print a verification free of charge via Find a PT or PTA. 

USE THIS FORM ONLY if you are a 3rd Party entity requesting verification of an Arizona licensed PT/PTA be sent directly by the Board to another entity, complete and submit this form with payment. NOTE: verifications may be printed free of charge via Find a PT or PTA.