Arizona Regulatory Board of Physician Assistants
Patricia McSorley, Executive Director
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  • Find your PA/Vol License
  • Licensure
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  • For Consumers
  • Laws & Rules
  • PA Center
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Forms
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Forms List

Adjudication Process
Application Fee Waiver Fillable 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.
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

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      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
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