ADA Accommodations For Testing
This form must be completed by those applicants seeking ADA Accommodations for the NPTE and/or AZLAW exams. Upload the completed form to your application and submit via the eLicensing system.
Arizona Statement of Citizenship and Alien Status Form
This form must be completed in its entirety by every applicant for PT licensure or PTA certification. Upload the completed form to your application through the eLicensing system.
Continuing Competence Audit Form
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.
Customer Satisfaction Survey
Dry Needling Training Submission Form
Use this form to submit completion documents demonstrating compliance with the rules for Dry Needling training and education.
Inactivate a PT License or PTA Certificate
If you wish to inactivate your AZ license or certificate, complete this form and upload to an inactivation service request through your eLicensing portal.
Interstate Telehealth Patient Encounter Reporting Form
Interstate Telehealth Provider Registry Instructions & Form
Complete this form if you are not licensed or certified in Arizona but seek to provide telehealth services in Arizona pursuant to A.R.S. § 36-3606.
Public Records/Directory Request Form
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.
A person may obtain additional public records related to any licensee or certificate holder, including dismissed complaints and non-disciplinary actions and orders, by contacting the board directly A.R.S. § 32-3214.
Contact Monica Crowley at [email protected] or 602-274-1072.
Reinstatement from Inactive/Not Practicing
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Not Practicing.
Reinstatement from Inactive/Retired
Use this form if you wish to reinstate or reactivate your license/certificate that currently displays a status and sub-status of Inactive/Retired.
Required Reinstatement Documents
Please complete the forms and upload the appropriate documents into the eLicensing System.
Retire a PT License or PTA Certificate
If you wish to retire your AZ license or certificate, complete this form and upload to a "retire" service request through your eLicensing portal. NOTE, retiring a license/certificate indicates you are no longer working as a PT/PTA in AZ or elsewhere.
Third Party Verification
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.
USE THIS FORM ONLY if you are a 3rd Party entity requesting verification of an Arizona licensed PT or certified PTA. Complete this form and submit with payment to request an official verification of licensure to be sent to another licensing board or college/university.