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License Application

Practitioner Application Packet  PDF
Practitioner License
Application   PDF
Applicant Minimum Participation Requirements Form  PDF
Supplemental Application: Authorization to Practice through Military Training or Experience Equivalency  PDF
Supplemental Application: Authorization to Practice for Military Spouse or Domestic Partner  PDF
Legend Drugs & Devices Continuing Education (Initial)  PDF
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License Renewal

Peer Review Summary Form  PDF
Client Declined MANA Reporting Form   PDF
Legend Drugs & Devices Continuing Education Transcript (Subsequent)  PDF
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Auscultated Acceleration Test

Auscultated Acceleration Test Standard  PDF
Auscultated Acceleration Test Graph  PDF
Auscultated Acceleration Test Examples  PDF​
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Information Update

Authorization Holder Information Update: Use this form to update your name, address, employment and any other changes.
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Consumer Forms

Complaint Form   PDF
Public Records Request Form   PDF
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Traditional Midwife Information Disclosure

Traditional Midwife Information Disclosure Form  PDF
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