The following forms are posted in Adobe Acrobat Reader (PDF) format.

Licensure Forms

    Address Change Request Form

    Application Packet Request Form

    Athletic Trainer's Responsible Physician and Protocol Form

    Credit/Debit Card Payment Authorization Form

    Foreign School Verification Request Form

    Institutional License Certification of Employment

    Name Change Form

    Notice of Termination of Supervision of a Physician Assistant Form

    Notification or Termination of Supervision of a Physical Therapist Assistant Form

    Physician Assistant's Responsible Physician and Drug Prescription Protocol

    Request for a Duplicate Certificate Form

    Status Change for the Allied Health

    Status Change for the Healing Arts

    Status Change to Military for all Professions

    USMLE Step 3 Application Form

    Verification of Kansas License or Registration Form

    Verification of Non-Kansas License Registration Form

Licensure APPLICATION Forms

FILLABLE FORMS (these may take extra time to download). These forms can also be printed, filled out and submitted.

  NON-FILLABLE FORMS

    (AT) Initial Licensing Application (1.78mb)

    (AT) Initial Licensing Application

    (AT) Reinstatement Application (1.75mb)

    (AT) Reinstatement Application

    (Contact Lens Distributor) (coming soon)

    (Contact Lens Distributor) (coming soon)

    (DC) (coming soon)

    (DC) (coming soon)

    (DO) Initial Licensing Application (please refer to the non-fillable form)

    (DO) Initial Licensing Application

    (DO) Reinstatement Application (coming soon)

    (DO) Reinstatement Application (coming soon)

    (DPM) (coming soon)

    (DPM) (coming soon)

    (Institutional) (coming soon)

    (Institutional) (coming soon)

    (LRT) Initial Licensing Application (1.65mb)

    (LRT) Initial Licensing Application

    (LRT) Reinstatement Application (1.63mb)

    (LRT) Reinstatement Application

    (MD) Initial Licensing Application (please refer to the non-fillable form)

    (MD) Initial Licensing Application

    (MD) Reinstatement Application (coming soon)

    (MD) Reinstatement Application (coming soon)

    (ND) Initial Licensing Application (1.65mb)

    (ND) Initial Licensing Application

    (ND) Reinstatement Application (1.63mb)

    (ND) Reinstatement Application

    (OT) / (OTA) Initial Licensing Application (1.65mb)

    (OT) / (OTA) Initial Licensing Application

    (OT) / (OTA) Reinstatement Application (1.63mb)

    (OT) / (OTA) Reinstatement Application

    (PA) Initial Licensing Application (1.90mb)

    (PA) Initial Licensing Application

    (PA) Reinstatement Application (1.88mb)

    (PA) Reinstatement Application

    (Post Graduate) Initial Licensing Application (1.72mb)

    (Post Graduate) Initial Licensing Application

    (PT) / (PTA) Initial Licensing Application (1.73mb)

    (PT) / (PTA) Initial Licensing Application

    (PT) / (PTA) Reinstatement Application (1.71mb)

    (PT) / (PTA) Reinstatement Application

    (RT) Initial Licensing Application (1.65mb)

    (RT) Initial Licensing Application

    (RT) Reinstatement Application (1.63mb)

    (RT) Reinstatement Application

    (Student RT) Initial Licensing Application (1.71mb)

    (Student RT) Initial Licensing Application

Licensure RENEWAL Forms

FILLABLE FORMS (these may take extra time to download)

NON-FILLABLE FORMS

    (MD) (1.40mb)

    (MD)

Legal Forms

    Complaint Form

Healthcare Facility Forms

    Report of Adverse Findings Form -
    (Form can be completed and then printed )

    (Form is only a printable form)

    Closed Claim Report Form -
    (Form is only a printable form)

Administrative Forms

    Credit/Debit Card Payment Authorization Form

    Query Order Form

Disciplinary Forms (if you answered yes to disciplinary questions please fill out the appropriate form)

    Question A

    Question B

    Question C

    Question D

    Question E

    Question F

    Question G