Forms

The following forms are in Adobe Acrobat format. You will need Acrobat to view and print these documents. Don't have it? You can down load it for free.

 

Address Change - Notification of address change. 

Board Approved Chiropractic Assistant Training Programs- List of approved providers of chiropractic assistant training.

Chiropractic Assistant Notification of Hire -Form for notifying the Board of a newly hired chiropractic assistant.

Chiropractic Assistant Notification of Termination - Form for notifying the Board of a terminated chiropractic assistant.

Chiropractic Assistant Registration -Instructions and form for registering any chiropractic assistants.

Chiropractic Assistant Training Requirements/Application and Sample Course Outline -Application to provide chiropractic assistant training.

Chiropractic Assistant Transfer Form - Form for transferring an assistant to a new doctor.

Chiropractic Licensing Information - General information regarding chiropractic licensing requirements in Arizona.  Includes a form to request applications for chiropractic licensure and certification in physiotherapy and acupuncture.

Complaint Form - Instructions and form to issue a complaint against a chiropractor.

Continuing Education - Course requirements and reporting.

Extern Application - Application for students for the preceptorship program. 

How and When to Apply for Continuing Education Course Approval - Not all continuing education requires board approval.  Use this form to determine if a specific continuing education course needs board approval and how request approval.

Inactive Chiropractic Licensing Application - Application for requesting inactive status for a active chiropractic license and related laws.

List of Reportable Criminal Charges and Arrests - Categories and types of 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.

Records Request - Form to request public records; agendas, minutes, mailing labels, lists, etc.

 Reinstatement Application -  Application to reinstate a license.  Laws governing reinstatement.

Reinstatement from Inactive to Active - Application to reinstate from an inactive to an active license.

Retirement Status Application - Application for retirement status for licensed chiropractors.

Request for Approval of Board Ordered CE- Form to have staff pre-approve Board ordered continuing education. NOT to be used for approval of continuing education for renewal.

Specialty Applications - Application for certification in acupuncture and physical medicine modalities and therapeutic procedures.

Verification of Licensure in Good Standing - Form to verify license status.

Verification Request Form - Form to request verification of licensure.