Applications and Forms
Podiatrist Applications
Contact PCS for all applications and testing information at:
Professional Credential Services, Inc. (PCS)
Tel. 877-887-9727 (toll free) or 615-880-4225
Website: www.pcshq.comFoot Screening Assessment Form for Nursing Homes
Foot Screening Assessment for Nursing Homes Information Sheet
Nursing Home Referral Letter
Form 1101
Form 1102
Verification Request
If you require a certificate of verification to go to another jurisdiction(s), please submit separate verification request forms with applicable fees for each verification requested.
Online Address Change for Podiatrists
The Online Change of Address feature allows you to change your address of record listed in our database. To use this function, you must provide certain information for authorization.
Change of Name or Request for Duplicate License for Board of Registration in Podiatry
This PDF form maybe used to request a name change, address change or a duplicate license.
Division of Professional Licensure Complaint Form
Health Care Fraud Complaint Application
Note: The Health Care Fraud Application is for use by insurance companies and fraud agencies.