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 | Customer Satisfaction Survey | 10/2012 |
| 4 | Customer Satisfaction Survey in Spanish | 11/01/2003 |
| 5 | Guidelines for Petitioners (For Use with All Petitions) | 05/01/2001 |
| 6 | Petition for Early Termination of Probation (Instructions) | 05/01/2001 |
| 7 | Petition for Early Termination of Probation (Form) | 05/01/2001 |
| 8 | Petition for Penalty Reduction (Instructions) | 05/01/2001 |
| 9 | Petition for Penalty Reduction (Form) | 05/01/2001 |
| 10 | Petition for Reinstatement of License (Instructions) | 05/01/2001 |
| 11 | Petition for Reinstatement of License (Form) | 05/01/2001 |
| 12 | Quarterly Probation Report | 07/01/2004 |
| 13 | Reporting Requirements for Prosecuting Agencies and Court Clerks | 07/01/2004 |
LICENSING FORMS & APPLICATIONS
| LINE | DESCRIPTION | REVISION DATE |
| 14 | Address Change Request | 12/2009 |
| 15 | Certification of Licensure and State Endorsement | 11/2003 |
| 16 | Chiropractic College Certificate | 02/2011 |
| 17 | Checksheet for Chiropractic License Application | 01/2013 |
| 18 | Corporation Registration | 10/2011 |
| 19 | Corporation Renewal Replacement Form | 02/2011 |
| 20 | (use for changes to existing corporations) | 02/2011 |
| 21 | Duplicate License/ Name Change | 10/2010 |
| 22 | Inactive to Active Status Application Information | 06/08/2011 |
| 23 | License Verification/Certification Request Form | 10/2010 |
| 24 | Live Scan Service Instructions and Form | 03/2002 |
| 25 | Name Change | 10/2010 |
| 26 | Prechiropractic Hours Verification | 02/2011 |
| 27 | Reciprocal License Application | 02/2011 |
| 28 | Referral Service Application | 11/2003 |
| 29 | 12/2010 | |
| 30 | Restoration of License | 06/08/2011 |
| 31 | Satellite Office (New, Renew, Cancel) | 02/2011 |
CONTINUING EDUCATION APPLICATIONS
| LINE | DESCRIPTION | REVISION DATE |
| 32 | Continuing Education Provider Application | 06/08/2011 |
| 33 | Continuing Education Course Application (Must be a Board approved provider before completing this application) | 06/08/2011 |
CHIROPRACTIC COLLEGE APPLICATIONS
| LINE | DESCRIPTION | REVISION DATE |
| 34 | Application for New Chiropractic College | 09/20/2006 |
AMBASSADOR REQUEST FORM
| LINE | DESCRIPTION | REVISION DATE |
| 35 | Ambassador Request Form | 02/20/2011 |
