Downloadable Application Kits for Lapsed License
A licensee who has ever held a full license in Massachusetts that was voluntarily not renewed or was revoked by operation of law must complete a lapsed application to revive their license.
Please read the instructions carefully before completing your application.
Remember: if your license lapses, YOU MAY NOT PRACTICE MEDICINE IN MASSACHUSETTS IN ANY FASHION OR CAPACITY UNTIL YOUR LICENSE IS REVIVED BY THE BOARD.
- Lapsed Application Kit file size 1MB
- Lapsed License Letter
- Lapsed License Instructions
- Lapsed License Checklist
- Lapsed License Application
- Lapsed License Supplement
- Medicare Tax Form
- Authorization for Release
Malpractice History Form
This information is provided by the Board of Registration in Medicine.