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AZ.gov Arizona's Official Website Arizona Board of Podiatry Examiners
Arizona Board of Podiatry Examiners AZ.gov Arizona's Official Web Site

All forms are in Adobe Acrobat format which must be installed before any forms  can be downloaded.  If you don't have Adobe Acrobat .


Forms and Applications

Complaint Form

Public Records Reproduction Request

Instructions and Information for completing the Application for a Podiatry License

Application for a Podiatry License

2013 License Renewal Form

2013 License Renewal Cover Letter/Instructions

Initial Registration to Dispense Drugs and Devices Form

Statement of Citizenship Form and Instructions

Customer Satisfaction Survey

Change of Address Form

About the Board’s use of your social security number: 

Pursuant to ARS §25-320, disclosure of your social security account number to this agency is required.  We request social security numbers of our applicants and licensees for the purpose of identification in carrying out our statutory functions.  Your social security number will not be released to the general public.  Your social security number may be released to authorized persons pursuant to a provision of the law.  Authorized persons include: an officer or employee of the United States; an officer or employee of any State, political subdivision of a State, or agency of a State or political subdivision of a State, or an officer or employee thereof, who is acting pursuant to a provision of law.  42 U.S.C. § 405(c)(2)(C)(vii)(III).  Upon request by the Arizona Department of Economic Security, your social security account number will be disclosed for purposes of establishing paternity pursuant to A.R.S. §12-2452 (F) and 25-320(K).  The Board may also use your social security number as a confidential identifier when inquiring about your education, background or fitness to practice.  (An example of this type of use would be to request information from the National Practitioner’s Data Bank).