Get Information Change Form - Arkansas State Board Of Physical Therapy - Arptb

The Information Change Form is an essential document for licensees of the Arkansas State Board of Physical Therapy to update their personal and professional information. Accurately completing this form ensures that your records remain current and compliant with board regulations.

Follow the steps to complete the online form efficiently.

1. Press the ‘Get Form’ button to access the form and open it in your editing tool.
2. Begin filling out Section A with your current personal information, including your first name, middle name or initial (if applicable), last name, and license number. Ensure that all entries are correct for accurate identification.
3. Proceed to Section B to input your new contact information. This section requires you to provide your new address, city, state, zip code, home phone number, work phone number, residence county, and email address.
4. If there are any changes related to your employment, fill out Section C, which includes the facility name and facility information, such as facility city and state.
5. For any name changes, navigate to Section D. Here, you are required to enter your new first name, middle name or initial, and last name. Remember to attach any legal documents that justify the name change, such as a marriage certificate or divorce decree.
6. In Section E, you must provide your signature and the effective date of the new information you entered. This finalizes your request for change.
7. Once you have reviewed all sections for accuracy, save your changes and choose to download, print, or share the completed form as needed.

Take action today and complete your documents online to ensure timely updates to your information.