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  • ALL APPLICANTS SHALL REVIEW INFORMATION REGARDING FINGERPRINTING SEE FINGERPRINT SUBMISSION TAB BELOW PRIOR TO APPLICATION SUBMISSION TO THE BOARD.

ALL APPLICANTS SHALL REVIEW INFORMATION REGARDING FINGERPRINTING SEE FINGERPRINT SUBMISSION TAB BELOW PRIOR TO APPLICATION SUBMISSION TO THE BOARD.

 

 

  • Licensing and Certification Forms
  • Request Forms
  • A and B List
  • Fingerprint Card Submission
  • Complaints
  • Interstate Telehealth Registration

Certificate to Dispense/Renewal Certificate to Dispense

Certificate to Dispense means an approval granted by the Board to dispense a natuural substance, drug, or device.  Defiinitions R-4-18-901 Qualifications  R4-18-902

Be aware that if you do not renew your Certificate to Dispense,  you will be subject to pay a renewal and late fee for each year the license has been expired. If you do not use your Certificate to Dispense,  you can CANCEL your Certificate to Dispense to avoid extra fees in the future, go to nd.az.gov then Forms →Request tab.     


PDF icon Certificate to Dispense Application, PDF icon CTD 2021 renewal app (1).pdf
Clinical Training Certificate No Longer Required

Rely on the Statutes and Rules for requirements to participate in Clinical training. The renewal date is the issue date of the Intial Clinical Certificate.

Conduct Preceptorship Certificate

This application is for a Naturopathic Doctor to conduct a preceptorship program this is a initial/renewal application.


PDF icon Preceptorship Conduct Application New and Renewal
Engage in Preceptorship Certificate

It is the responsiblity of  the certifiacate holder  to renew in a timely manner. A renewal application must be recieved by or on 7/1/2017 to avoid a late fee.   


PDF icon Preceptorship Training Renewal, PDF icon Precept. Engage App June 2023.pdf
Medical Assistant Application / Medical Assistant Renewal

Read the application and requirements prior to applying for a Medical Assistant Certificate.


PDF icon Medical Assistant Renewal Application_Revised 2023.pdf, PDF icon Medical Assistant Application June 2023.pdf
Medical License Reinstatement Form

Read the application for reinstating prior to applying


PDF icon ADDRESS OF RECORD2021.pdf, PDF icon Reinstatement Application August 2023.pdf
Naturopathic Medical License

Please review Medical License application prior to applying, you will apply based on exam , endorsement or universal recognition.


PDF icon ADDRESS OF RECORD2021.pdf, PDF icon Application Form Revised August 2023.pdf
Specialist Certificate

Specialist Certificate shall meet the requirements of A.R.S. Title 32 Chapter 14.


PDF icon Specialty Certificate Application.pdf

Address/Name Change
This is a fillable form, you will need to save changes and email the form to [email protected] print and send via mail to 1740 W. Adams, Ste. 3002 Phoenix, AZ. 85007 
PDF icon Address Name Change 2017 WF.pdf
License Verification Request
This is a form to request a written verification of your Arizona Naturopathic Medical license to be sent to another state or agency.  The verification will include, issue date, expiration date,also disciplianary actions if any.  A $5.00 fee is to accompany the request made payableto AZND Board.
PDF icon Verification Request.pdf
Medical Consultant Request PDF icon Medical_Consultant.pdf
Public Records Request Form
This is a fillable form, your will fill out the form, the you will print and sign. You can mail the form with the fee,  if there is no fee you can email or fax. 
PDF icon Public Information Request
Retire/Cancellation Request Form
Use the form if you would to retire your Naturopathic License or Cancel a Certificate.You can email, or U.S. mail this document.
PDF icon Retire/Cancellation Request Form

 

 

EVIDENCE OF U.S. CITIZENSHIP, U.S NATIONAL STATUS, OR ALIEN STATUS

Please utilize LiveScan through Fieldprint, which is a State of AZ contracted company. 

You will make an appointment at a location near you and get the prints scanned. You can sign up for Fieldprint at https://arizona.fieldprint.com/User/SignIn?ReturnUrl=%2f and use Reason Code XXX-012.A

 

As an alternative, fingerprints may be rolled on a FD-258 card. Most police stations can do this step.  It will be the responsibility of the Applicant to send the fingerprint card, along with a money order made payable to DPS in the amount of $22.00 to the Board’s administrative office. Please be aware: the only form of payment with this method is a Money Order. Additionally, this method does take longer for the Board to receive the background reports, and there is a greater risk of rejected prints. Rejected prints will require the applicant to submit a second set of prints to the Board and cause an additional delay in reporting.

Please utilize LiveScan through Fieldprint, which is a State of AZ contracted company. 

You will make an appointment at a location near you and get the prints scanned. You can sign up for Fieldprint at https://arizona.fieldprint.com/User/SignIn?ReturnUrl=%2f and use Reason Code XXX-012.A

 

As an alternative, fingerprints may be rolled on a FD-258 card. Most police stations can do this step.  It will be the responsibility of the Applicant to send the fingerprint card, along with a money order made payable to DPS in the amount of $22.00 to the Board’s administrative office. Please be aware: the only form of payment with this method is a Money Order. Additionally, this method does take longer for the Board to receive the background reports, and there is a greater risk of rejected prints. Rejected prints will require the applicant to submit a second set of prints to the Board and cause an additional delay in reporting.

Please utilize LiveScan through Fieldprint, which is a State of AZ contracted company. 

You will make an appointment at a location near you and get the prints scanned. You can sign up for Fieldprint at https://arizona.fieldprint.com/User/SignIn?ReturnUrl=%2f and use Reason Code XXX-012.A

 

As an alternative, fingerprints may be rolled on a FD-258 card. Most police stations can do this step.  It will be the responsibility of the Applicant to send the fingerprint card, along with a money order made payable to DPS in the amount of $22.00 to the Board’s administrative office. Please be aware: the only form of payment with this method is a Money Order. Additionally, this method does take longer for the Board to receive the background reports, and there is a greater risk of rejected prints. Rejected prints will require the applicant to submit a second set of prints to the Board and cause an additional delay in reporting.

Please utilize LiveScan through Fieldprint, which is a State of AZ contracted company. 

You will make an appointment at a location near you and get the prints scanned. You can sign up for Fieldprint at https://arizona.fieldprint.com/User/SignIn?ReturnUrl=%2f and use Reason Code XXX-012.A

 

As an alternative, fingerprints may be rolled on a FD-258 card. Most police stations can do this step.  It will be the responsibility of the Applicant to send the fingerprint card, along with a money order made payable to DPS in the amount of $22.00 to the Board’s administrative office. Please be aware: the only form of payment with this method is a Money Order. Additionally, this method does take longer for the Board to receive the background reports, and there is a greater risk of rejected prints. Rejected prints will require the applicant to submit a second set of prints to the Board and cause an additional delay in reporting.

Applicants Requiring Fingerprint Card Submission
9/2020 Notice to Applicant: Your fingerprints will be used to check the criminal history records of the FBI If you have a criminal history record, the officials making a determination of your suitability for the job, license, or other benefit must provide you the opportunity to complete or challenge the accuracy of the information in the record. You should be afforded a reasonable amount of time of 30 days to correct or complete the record (or decline to do so) before officials deny you the job, license, or other benefit based on information in the criminal history record. The procedures for obtaining a change, correction, or updating of your FBI criminal history record are set forth in Title 28, Code of Federal Regulations, Section 16.30 through 16.34. Information on how to review and challenge your FBI criminal history record can be found at www.fbi.gov under "Identity History Summary Checks" or by calling (304) 625-5590. To obtain a copy of your Arizona criminal history in order to review/update/correct the record, you can contact the Arizona Department of Public Safety Criminal History Records Unit at (602) 223-2222 to obtain a fingerprint card and a Review and Challenge packet. Information on the review and challenge process can be found on the DPS website www.azdps.gov 

Applications that require Fingerprint Card Submission

Clinical Certificate
Engage in Preceptorship Certificate
Medical Assistant
Reinstatement Application
Intial Medical License Application 

Also Review FBI Privacy Act Statement

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:81b6c5c9-43f4-438e-af20-f353dc619b19

To file a complaint against a Naturopathic Physician, download and complete the form. You may email to form directly to us, or mail the form. 

The complaint form is located on the home page.

  • License Renewal Form
  • Interstate Telehealth Registration
  • Medical Consultant Request
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Arizona Naturopathic Physicians Medical Board
1740 W. Adams Ste. 3002
Phoenix, AZ 85007
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Phone: 602-542-8242
Fax: No longer using
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