Forms

Complaints and Enforcement

The following forms are commonly used by the Complaints and Enforcement Divisions: 

• Form to File a Complaint
• Compliance Inspection Form 

Licensees and License Applicants

The following forms are commonly used by Licensees and License Applicants: 

• ADA Accommodation Request Form 
• Letter of Good Standing 
• Notice to Clients 
• Petition for Criminal History Evaluation prior to licensure 
• Register a Temporary Limited-Service Clinic 
• Report of Criminal Activity 
• Practice Location Update Request

Miscellaneous Forms

The following forms are generally used by various types of users: 

• Notice of Name Change Request Form
• Open Records Request Form 
• Licensee Mailing List Order Form 
• Release of Information Authorization

Sterilization Information

• Sterilization Information – (English) 
• Sterilization Information – (Spanish)