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Payment Forms for New CBC (Previous CBC Canceled after 90 Days)

After a criminal background check (CBC) request is canceled due to inactivity, an additional $32 fee must be paid before a new CBC request may be initiated. Please select the appropriate form for your Health Licensing Board, then complete it and submit directly to your board along with the payment.

Board Forms:

Board of Behavioral Health and Therapy
Board of Medical Practice
Chiropractic Board
Board of Dentistry
Dietetics and Nutrition Board
Marriage and Family Therapy
Board of Nursing
Nursing Home Adminstrators Board
Occupational Therapy Board
Optometry Board
Pharmacy Board
Physical Therapy Board
Board of Podiatric Medicine
Psychology Board
Board of Social Work
Board of Veterinary Medicine

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