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Forms

Online Forms

Address or Employment Change
License Inquiry (public licensee database)
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Consumer Forms

Consumer Complaint Form   WORD
Public Records Request Form   WORD

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For Licensees and Applicants

Customer Information Update Form  WORD | PDF
Renewal, Late Fee, Address or Employment Change, Replacement License 

Affidavit of Licensure  WORD | PDF

Accommodation Request  WORD | PDF​ (Americans with Disabilities Act)

Fingerprint Processing Instructions and Form  WORD | PDF​

Name Changes Information / Requirements  PDF

Name Change Form  WORD | PDF

Written and Practical Examination Application  WORD | PDF​

Supplemental Application: Authorization to Practice through Military Training or Experience Equivalency WORD | PDF

Supplemental Application: Authorization to Practice for Military Spouse or Domestic Partner WORD | PDF​

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Submit Form(s) to HLO

ODVA You may print and return completed forms to:

Health Licensing Office
700 Summer Street NE, Suite 320
Salem, OR  97301-1287
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