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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  PDF
Public Records Request Form   PDF

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For Licensees and Applicants

Authorization Holder Information Update Form PDF
Renewal, Late Fee, Address or Employment Change, Replacement License 

Affidavit of Licensure  PDF

Accommodation Request  PDF (Americans with Disabilities Act)

LiveScan Fingerprint Instructions and Form  PDF

Name Change Information / Requirements  PDF

Licensee Legal Name Change Update Form  PDF

All Boards Written and Practical Examination Application  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

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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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