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)
  • Authorization for Release of Information for the Subject of the Complaint (PDF)
    AND one of the following:
    • Physician/Provider/Facility Authorization for Release of Information (PDF) OR
    • Kaiser Authorization for Release of Information (PDF)
• Continuing Medical Education Waiver Application (PDF)
• Customer Service Satisfaction Survey
• Duplicate License Request (PDF)
• Fingerprint Card Request
• Health Facility/Peer Review Reporting Form (805) (PDF)
• Inactive License Status Request (PDF)
• License Renewal Application (by mail) (PDF)
• License Renewal Application (online)
• Live Scan Service (PDF)
• Mandatory Reporting Requirements
• Petition for Penalty Relief
  • Instructions for Completing the Petition for Penalty Relief (PDF)
  • Petition for Penalty Relief Form – Fill-In (PDF)
  • Live Scan Form (PDF)
  • Live Scan Locations
  • Department of Motor Vehicles (DMV)
  • National Practitioner Data Bank (NPDB)
• 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

Outreach

• School Presentation Application (PDF)