Licensees and certificate holders may use this form to independently track their own continuing competence activities. If audited, this form is to be downloaded and submitted electronically, with all associated continuing competence certificates of completion, to the Board office. Licensees and certificate holders selected for continuing competence audit will be noticed via certified mail.

DO NOT USE this form if you have ever been a licensed PT or certified PTA in Arizona.  Previous or current AZ licensed PTs and certified PTAs must log into eLicensing to submit a Service Request for a license verification to be sent to another licensing board. If you have trouble logging into eLicensing contact staff. 

Complete this form to request copies of records, including a Directory of Arizona PTs &/or PTAs. Fees are charged for copies of certain records. Mail completed form & payment to the Board's office as indicated on the form. Credit card payments are not accepted for Public Records requests.