Arizona Regulatory Board of Physician Assistants

Prescribing Authority Form - Effective Janurary 01, 2011
Supervising Physician Prescribing Authority Form

Physician Assistant Complaint Form
To file a complaint against an P.A. licensed in Arizona, download this printable form which includes detailed instructions

Physician Complaint Form
To file a complaint against an M.D. licensed in Arizona, download this printable form which includes detailed instructions

Public Information Request Form
To request public information, download this printable form which includes detailed instructions

License Verification Request Form
To request that a license verification (sometimes called a letter of good standing) be sent to another board or organization.

Data Disk Order Form
To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions

Medical Directory Order Form
To request a Physician and Physician Assistant Directory via website download or via printable request form

Change of Address Form
Licensees must notify the Board in writing within thirty (30) days of any address changes

Legal Name Change Form
To notify the Board of a legal name change, download these printable forms including payment instructions.

Notice to Patients Form
A.R.S.§ 32-2501(21)(hh) requires that a physician assistant notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician assistant is referring the patient.

The statute requires that a physician assistant use this Board prescribed form.

Termination of Supervision
To terminate (end) supervision of a Physician Assistant, download this printable form to complete and return to the board.

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