Forms and Publications

NOTE: THE BOARD DOES NOT ACCEPT CASH.
ALL PAYMENTS MUST BE MADE BY EITHER CHECK OR MONEY ORDER

ENFORCEMENT FORMS

Form Description Revision Date
1 Complaint Form 11/01/2003
2 Complaint Form in Spanish 11/01/2003
3 Guidelines for Petitioners (For Use with All Petitions) 05/01/2001
4 Petition for Early Termination of Probation (Form) 05/01/2001
5 Petition for Early Termination of Probation (Instructions) 05/01/2001
6 Petition for Penalty Reduction (Instructions) 05/01/2001
7 Petition for Penalty Reduction (Form) 05/01/2001
8 Petition for Reinstatement of License (Instructions) 05/01/2001
9 Petition for Reinstatement of License (Form) 05/01/2001
10 Quarterly Probation Report 07/01/2004
11 Reporting Requirements for Prosecuting Agencies and Court Clerks 07/01/2004

LICENSING FORMS & APPLICATIONS

Form Description Revision Date
12 Address Change Request 12/2009
13 Certification of Licensure and State Endorsement 11/2003
14 Chiropractic College Certificate 02/2011
15 Chiropractic License Application 01/2013
16 Corporation Registration 10/1/2013
17 Corporation Renewal 02/2011
18 Corporation Special Report
(use for changes to existing corporations)
02/2011
19 Duplicate License/Name Change 10/2010
20 Inactive to Active Status Application Information
Inactive to Active Status Application
06/08/2011
21 License Verification/Certification Request Form 10/2010
22 Live Scan Service Instructions and Form 03/2002
23 Prechiropractic Hours Verification 02/2011
24 Reciprocal License Application 02/2011
25 Referral Service Application 11/2003
26 Replacement License Renewal Form 12/2010
27 Restoration of License 04/2011
28 Satellite Office (New, Renew, Cancel) 02/2011

CONTINUING EDUCATION APPLICATIONS

Form Description Revision Date
29 Continuing Education Provider Application 02/2010
30 Continuing Education Course Application
(Must be a Board approved provider before completing this application)
02/2010

CHIROPRACTIC COLLEGE APPLICATIONS

Form Description Revision Date
31 Application for New Chiropractic College 09/20/2006

AMBASSADOR REQUEST FORM

Form Description Revision Date
32 Ambassador Request Form 02/20/2011