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FORMS
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)
    (AT)    
    (Contact Lens Distributor) (coming soon)    
    (DC) (coming soon)    
    (DO) (coming soon)    
    (DPM) (coming soon)    
    (Institutional) (coming soon)    
    (LRT) (coming soon)    
    (ND) (coming soon)    
    (MD) (coming soon)    
    (OT) (coming soon)    
    (OTA) (coming soon)    
    (PA)    
    (PT)    
    (PTA)    
    (RT)    
     
    NON-FILLABLE FORMS    
    (AT) (coming soon)    
    (Contact Lens Distributor) (coming soon)    
    (DC) (coming soon)    
    (DO) (coming soon)    
    (DPM) (coming soon)    
    (Institutional) (coming soon)    
    (LRT) (coming soon)    
    (MD) (coming soon)    
    (ND) (coming soon)    
    (OT) (coming soon)    
    (OTA) (coming soon)    
    (PA) (coming soon)    
    (PT) (coming soon)    
    (PTA) (coming soon)    
    (RT) (coming soon)      
 

Licensure RENEWAL Forms

 
    FILLABLE FORMS (these may take extra time to download)
 
    (MD) Medical Doctor (1.35mb)    
    (DO) Osteopathic Doctors (1.35mb)    
    (DPM) Podiatric Doctors (1.32mb)    
    (LRT) Licensed Radiologic Technologists (1.28mb)    
     
    NON-FILLABLE FORMS    
     
    (DO) Osteopathic Doctors    
    (DPM) Podiatric Doctors    
    (LRT) Licensed Radiologic Technologists    
     

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)  

Administrative Forms
    Credit/Debit Card Payment Authorization Form  
    Query Order Form  


Forms are posted in Adobe Acrobat Reader (PDF) format.

Graphic Logo for Adobe Acrobat ReaderYou may download a FREE version of the Acrobat Reader here

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Kansas State Board of Healing Arts
235 S. Topeka Boulevard   -  Topeka, KS 66603-3068
Phone: (785) 296-7413  -  Toll Free: 1-888-886-7205  -  Fax: (785) 296-0852
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