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

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. Certificate to Dispense Application, CTD 2021 renewal app (1).pdf
Clinical Training Certificate No Longer Required
Conduct Preceptorship Certificate This application is for a Naturopathic Doctor to conduct a preceptorship program this is a initial/renewal application. 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. Preceptorship Training Renewal, Precept. Engage App November 2023.pdf, Background Check Procedures and Instructions.pdf
Medical Assistant Application / Medical Assistant Renewal Read the application and requirements prior to applying for a Medical Assistant Certificate. Medical Assistant Renewal Application_Revised 2023.pdf, Medical Assistant ApplicationNovember 2023.pdf
Medical License Reinstatement Form Read the application for reinstating prior to applying ADDRESS OF RECORD2021.pdf, Reinstatement Application November 2023.pdf, Background Check Procedures and Instructions.pdf
Naturopathic Medical License Please review Medical License application prior to applying, you will apply based on exam , endorsement or universal recognition. ADDRESS OF RECORD2021.pdf, Medical License Application Form Nov. 2023.pdf, Background Check Procedures and Instructions.pdf
Specialist Certificate Specialist Certificate shall meet the requirements of A.R.S. Title 32 Chapter 14. 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	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.	Verification Request.pdf
Medical Consultant Request	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.	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.	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.