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License Application Packets and Forms 

(includes Fact Sheets with licensure eligibility requirements and history)

Note:  PDF's and external links will open in a separate window


Acupuncturists


Athletic Trainer


Naturopathic Doctor


Physicians (FCVS may be used for verifications of medical education, postgraduate training, and ECFMG certification)

The following individual forms are included in the packet but can also be downloaded separately:

Certification of Medical Education (PDF)

Facilities List (PDF)

Hospital Privileges Verification (PDF)

Malpractice History Report (PDF)

Physician Recommendation (PDF) 

Physician_Verification_of_Licensure (PDF)

Temporary Permit Application (PDF)

Treating Physician Statement (PDF)

Verification of Postgraduate Medical Training (PDF)

Verification of Specialty Board Certification (PDF)


  • Physician Application Option 2 - Uniform Application (aka UA)  This application is partially submitted online for the basic core of information that may be shared with other states accepting the UA.  Minnesota has a specific addendum addressing our state requirements.  The Uniform Application for Physician State Licensure (UA) allows for quick, easy and convenient single and multi-state licensure application.  The Federation of State Medical Boards (FSMB) began collecting a one-time $50 physician service charge from all applicants utilizing the benefits of the Uniform Application for Physician State Licensure (UA) on October 27, 2011.  See http://www.fsmb.org/ua-faqs.html for details.   If you have previously used the UA application, review all fields to ensure information is accurate and updated  prior to submission.

          See the 2014 Board Meeting Schedule for the application deadlines.

Other Physicians Forms


Physicians Assistants


Professional Firms


Respiratory Therapists


Traditional Midwives