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 or PTA licensure. Upload the completed form to your application through your Applicant Portal.
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 or PTA License
If you wish to inactivate your AZ PT or PTA license, complete this form and upload to an inactivation status change request through your Licensee Portal.
Interstate Telehealth Patient Encounter Reporting Form
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.
Required Reinstatement Documents
Please complete the forms and upload the appropriate documents into the eLicensing System.
Retire a PT or PTA License
If you wish to retire your AZ license, complete this form and upload to a "retire" status change request through your Licensee portal. NOTE, retiring a license 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/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