AZ Regulatory Board of Physician Assistants

provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents.

Application Fee Waiver Instructions

Instructions for the Application Fee Waiver Form

Application Fee Waiver Static Form

provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents.

CME Extension Request Form

Use this form to request an extension to complete CME

Combined CME Table effective 09/06/2019

Complaint and Investigation Process Summary

Complaint Form

Data Disk Order Form

To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions|(Providing an electronic medium containing public information about licensed physicians: $100.00*)

Juror Medical Excuse Form

Should a patient request that they be excused from jury service for reasons related to mental or physical conditions

Legal Name Change Form

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

License Verification Request Form

(Verifying a license: $10.00 per request*)

Medical Directory Download

Downloadable Physician and Physician Assistant Directory

Medical Directory Order Form

(Providing a copy of annual allopathic medical directory: $30.00*) Use this form to request a Physician and Physician Assistant Directory

Moral Turpitude Offenses

Notice Requirements Form

Notice to Patients Form

A.R.S.§ 32-2501(21)(ii) 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.

PA Duplicate License Form

PA Inactivation Or Cancellation Form

PA Inactivation or Cancellation Form

PA License Application Form

PA Military Waiver Form

PA Military Waiver Instruction Form

PA Renewal Application Form

PA Universal Recognition License Application

PA Universal Recognition License Application - Fillable

PA Volunteer Health Services Registration

Prescribing Authority - Prescribing Modification Form

Supervising Physician Prescribing Modification Form

Public Information Request Form

To request public information, download this printable form which includes detailed instructions|(Providing a copy of records, documents, letters, minutes, applications, and files, $1.00 for the first three pages and $0.25 for each additional page*)

Reportable Misdemeanors

(Misdemeanor offenses that have been determined to affect patient safety and are reportable under A.R.S. § 32-3208 by a licensee or license applicant. Other misdemeanors reportable under A.R.S. § 32-3208 besides those specifically listed within this document include any comparable charges filed against an Arizona licensee or license applicant by any other state, territory or country.)

Temporary Emergency License for COVID-19 Announcement

Temporary Emergency License for COVID-19 State of Emergency

The Board's Complaint Process

			Contact Us
	Address:		1740 W Adams, Suite 4000 Phoenix, AZ 85007
	Hours:		8am - 5pm Mon - Fri
	Phone:		(480) 551-2700
	Toll Free:		(877) 255-2212
	Fax:		(480) 551-2702
	Email:		Contact the Board