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Arizona Regulatory Board Of Physician Assistants
Arizona Regulatory Board of Physician Assistants

Prescribing Authority - Prescribing Modification Form
Supervising Physician Prescribing Modification Form

Physician Assistant Complaint Form
To file a complaint against an P.A. licensed in Arizona, download this printable form which includes detailed instructions


Physician Complaint Form
To file a complaint against an M.D. licensed in Arizona, download this printable form which includes detailed instructions


Public Information Request Form
To request public information, download this printable form which includes detailed instructions


License Verification Request Form
To request that a license verification (sometimes called a letter of good standing) be sent to another board or organization.

Juror Medical Excuse
Should a patient request that they be excused from jury service for reasons related to mental or physical conditions

CME Extension Request Form
Use this form to request an extension to complete CME

Data Disk Order Form
To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions

Medical Directory Order Form
To request a Physician and Physician Assistant Directory via website download or via printable request form

Legal Name Change Form
To notify the Board of a legal name change, download these printable forms including payment instructions.

Notice to Patients Form
A.R.S.§ 32-2501(21)(hh) requires that a physician assistant notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician assistant is referring the patient.

The statute requires that a physician assistant use this Board prescribed form.

PA Renewal Form
Paper version of PA Renewal Form

PA Inactivation Or Cancellation Form dated Nov 1, 2016
PA Inactivation or Cancellation Form

A.D.O.T. Vision Examination Report, 32-4001
To document a patient’s visual impairment which may restrict driving

A.D.O.T. Driver Condition/Behavior Report, 96-0469
To report any patient condition or behavior which may restrict driving

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