The following services can be submitted in the BOARDAL, and do not require payment:
| Service | Description | How to Submit |
|---|---|---|
| Change of Name and Address (including employment changes) |
Board rules require that applicants or licensees report any change in contact information within 30 days of the change. Name changes require documentation (see directions). Applicants: If you have a pending application, and you are NOT licensed by the Board, please email [email protected]. You cannot make changes in the Boardal. |
Licensees: LICENSEE PORTAL Applicants: [email protected] |
| Clinical Supervisor Registration form | Individuals who wish to be added or updated on the Clinical Supervisor Registry, or wish to have their education reviewed for compliance should complete. |
(Authorizations) |
| Complaint Form | The online complaint form is used for an individual or agency to file a complaint against a licensed practitioner or applicant for licensure. Please also see our video that explains the complaint process. | ONLINE COMPLAINT |
See services below that require payment with the submission method options.
| Service | Description | Click Link to Access | Fee |
|---|---|---|---|
| Verification of Licensure (including those needed for other states) |
Licenses can be verified in the Online Registry, but if a state seal is required or there are additional forms needed, request a license verification. You will be provided an opportunity to attach forms for completion. Please note: If you are no longer licensed by the Board, you must submit your request here. |
LICENSEE PORTAL |
$20.00 |
| Inactive Status Request or Extension to an Inactive Status Request | Pursuant to A.A.C. R4-6-305, licensees can request to put their license on inactive status, or request an extension to an inactive status (requires Board approval) |
SUBMIT ONLINEPRINT PDF |
$100.00 |
| Public Records Request | Records available for public inspection may be requested such as: licensure/application documentation (DO NOT use this option for license verifications, use the Verifications of Licensure service above), meeting audio and a mailing list of licensees. Fee varies by request. |
SUBMIT ONLINEPRINT PDF |
Varies |
| Investigative Report Request | An applicant or licensee who is the subject of an investigation, or their attorney has the ability to request a copy of the investigative report prior to a Board meeting. |
SUBMIT ONLINEPRINT PDF |
$25.00 for electronic records |
| License Renewal | All renewals require completion of the Arizona Statutes/Regulations Tutorial. If you have completed the tutorial and wish to submit your renewal, it can be completed in the Licensee Portal. You may also log your continuing education in the Licensee Portal at any time. | $325.00 |
The following forms must be submitted to the Board with a personal check (for fees of $40 or less), money order or cashiers check.
| Service | Description | Form | Fee |
|---|---|---|---|
| License Synchronization | Licensees with multiple licenses issued by AZBBHE may request that their expiration dates be synchronized at the time of renewal of both licenses. | PRINT PDF | Varies |
| Rule and Statute Book Order | Rule and statute books are available for purchase. | PRINT PDF | $10.00 |
Sample client forms - provided for sample purposes only, not required.
The following SAMPLE forms include the required elements to meet Board rules:
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