Arizona Osteopathic Board
Justin Bohall, Executive Director
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  • Find your DO/Resident License
  • Licensure & Compact
  • Osteopathic Board
  • For Consumers
  • Laws & Rules
  • DO Center
  • Forms
Forms
  • Forms
Forms List

Retired Status Renewal
Application Fee Waiver Form
Application Fee Waiver Form Instructions
AZ DO Physician Credentialing Data File Order Form
To order a current data file containing the Osteopathic (D.O.) Physician Database, download this printable form which includes detailed instructions. This data file is transmitted by email only. Please provide a valid email address when ordering.
AZ DO Public Information Request Form
To request public information, download this form which includes detailed directions.
CME Audit Reporting Form
If your license was randomly selected for CME audit, or you are requesting an extension, you must report your completed CME activities for this renewal cycle. When you have completed your required CME, type the information in this form on your computer, print and sign, and email, mail, or fax with copies of Certificates of Completion or your AOA CME Activity Report.
D.O. Temporary License List
Death Certificates - Training & Process
Dispensing Initial Registration Form
Use this form if this is the first time you have registered to dispense medications from your practice, or if your registration has expired.
Dispensing Registration Renewal
Disposal of Inventory of Drugs and Devices
If you have had a Registration to Dispense and are NOT Renewing it, YOU MUST use this form and disclose IN WRITING how you dispose of your inventory within 30 days of expiration pursuant to A.R.S. § 32-1871(F). This is required whether you are in private practice or employed. An example of how to complete this form is included on the second page of this document.
DO Resident List
Fingerprinting Instructions and Additional Documents for the Application.
Instructions for the Postgraduate Training Permit Initial Application
Please download and follow instructions for completing the PGT permit application. Following the instructions will prevent delays.
License Verification Request Form
Locum Tenens Registration Application
Locum Tenens Registration Application Instructions
Notice to Patients Form
"A.R.S. 32-1401(26)(gg) requires that a physician notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician is referring the patient." The statute requires that a physician use this Board prescribed form.
Postgraduate Training Permit Initial Application
For new D.O. interns, residents and fellows in an osteopathic or allopathic PGT program in Arizona who do not currently have an active permit for their new program or whose permit has expired. If you are a D.O. and currently hold an active permit,please use the Postgraduate Training Renewal Application.
Postgraduate Training Permit Renewal Application
For D.O. trainees who currently hold an active PGT permit and are continuing in their current program for the next academic year.
Pro Bono Registration Application
Request for Cancellation / Retired License
Request for Extension of Time to Comply with CME Requirement
By filing this request for extension, you are automatically included in the CME Audit. Carefully read the requirements listed on this form for completing the renewal of your license when filing an extension. This form can be completed in Adobe Acrobat and submitted by email to the Board.
Request for Waiver of CME Requirement
Waivers are governed by A.R.S. section 32-1825(C) and AAC R4-22-207. Filing a Waiver request does not exempt you from having to pay renewal or late filing of renewal fees if applicable. Please review the requirements for Waivers as listed on the form. This form can be completed in Adobe Acrobat and submitted by email to the Board.
Retired Status Affidavit
Use this form if you are licensed in Arizona, are permanently retired from the practice of medicine and want to have your license renewal fee and CME requirements waived. For more information, please review A.R.S. § 32-1832)
Teaching License Application
Use this application if you are not licensed in Arizona and plan to be employed as a full-time faculty member of a school of osteopathic medicine or an accredited teaching hospital’s graduate medical education program in Arizona. For more information, please review A.R.S. § 32-1831
Temporary License Application and Instructions
An approved temporary license allows applicants for full licensure to practice medicine in Arizona while completing the full license application process. Applicants for a full license who meet all of the qualifications per A.R.S. § 32-1834 may apply for a temporary license. Details are provided in the application instructions.
Volunteer License List

Osteo Board Seal
      Contact Us
Arizona Board of Osteopathic Examiners
in Medicine and Surgery
   Address:   1740 W Adams, Suite 2410
Phoenix, AZ 85007
   Hours:   8am - 5pm Mon - Fri
   Phone:   (480) 657-7703
   Email:   Contact the Board
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