Forms
- Application for Physician Assistant Licensure (online)
- Arrest, Criminal Action, Conviction, and Disciplinary Action Reporting (PDF)
- Authorization for Release of Information for the Subject of the Complaint (PDF)
- Birth Month Licensure (PDF)
- Change of Address
- Change of Name
- Complaint Form (PDF)
- Continuing Medical Education Waiver Application (PDF)
- Customer Service Satisfaction Survey
- Duplicate Pocket License - The Board is no longer issuing pocket licenses upon the approval of an initial license or renewal application. Licensees can print the pocket license by logging into their BreEZe account and selecting "Print License Certificate – Physician Assistant Pocket Cert PPAPA" from the drop-down menu under the "Manage Your License Information" section. Once selected, the pocket license certificate will open as a PDF on a separate tab.
- Duplicate Wall Certificate Request
- Fingerprint Card Request
- Health Facility/Peer Review Reporting Form (805) (PDF)
- Inactive License Status Request (PDF)
- License Renewal Application (PDF)
- License Renewal Application (online)
- Live Scan Service (PDF)
- Mandatory Reporting Requirements
- Petition for Penalty Relief
- Retired License Status Application
- Training Program Certification
- Verification of License
Complaint Information
- General Complaint Information
- Fill In and Print a Complaint Form in English (PDF)
- File a Complaint Electronically to the Department of Consumer Affairs