Applicants for licensure in Massachusetts may download any or all of the following forms for use in preparing their application.
All forms are Adobe Portable Document Format (PDF) files. You must have the Adobe Acrobat Reader Plugin for your browser in order to download and use these forms. Acrobat Reader is a free download from Adobe. It can be obtained by clicking on this link . First download the reader, then run the installation program to add the plugin to your browser.
Please read the instructions carefully before completing your application, and remember: your license expires at 11:59 p.m. on your birthday. If the Board has not renewed your license by your birthday in your renewal year, YOU MAY NOT PRACTICE MEDICINE IN MASSACHUSETTS IN ANY FASHION OR CAPACITY.
Additional Assorted Forms
- On-Line NPI Application
- Renewal Instructions
- Form R
- Office Based Surgery Form
- License Verification Request Form
- CPD Booklet
- CPD Waiver Form
- Application for Inactive Status
- Application for Active Status
- Application to Retire
- Replace a Lost Wallet Card
- Name Change
- Affiliation Agreement Form
- Fifth Pathway Form
This information is provided by the Board of Registration in Medicine.