Licensure Forms

The forms on this page were created using Adobe Acrobat. They are best viewed with that software or Acrobat Reader. If your browser does not support this feature, please save the document to your local computer and then open it directly in one of the Acrobat applications. Adobe Acrobat Reader is available at no charge from Adobe (click the Get Adobe Acrobat Reader link below to download the software):

Get Adobe Acrobat Reader

Attention Acupuncturists, Athletic Trainers, Chiropractors, Physical Therapists, Physical Therapist Assistants, Physicians, Physician Assistants, Occupational Therapists, Occupational Therapy Assistants, Podiatrists, Radiologic Technologists, and Respiratory Therapists:

The Board has contracted with VeriDoc for expedited license verification to other state medical boards for the above mentioned professions. Verification is convenient and virtually instantaneous. To obtain verification of your Kansas license, go to to use their secure site any time, day or night. If you have problems with the online verification process, call VeriDoc support at (701)319-6500 or email them at The Board will implement this service for other professions as it becomes available.

Sports Waiver (S.W.)

Telemedicine Waiver (T.W.)

Athletic Trainer (A.T.)

Corporate Practice of Medicine (CPM)

Independent Certified Nurse Midwife (CNM-I)

Contact Lens Distributor

Doctor of Chiropractic (D.C.)

Doctor of Medicine and Surgery (M.D.)

Doctor of Naturopathic Medicine (N.D.)

Doctor of Osteopathic Medicine and Surgery (D.O.)

Doctor of Podiatric Medicine (D.P.M.)

Licensed Acupuncturist (L.Ac.)

Occupational Therapist (O.T.)

Occupational Therapy Assistant (O.T.A.)

Physician Assistant (P.A.)

Physical Therapist (P.T.)

Physical Therapist Assistant (P.T.A.)

Radiologic Technologist (L.R.T.)

Respiratory Therapist (R.T.)