Get Change Of Address Form - Arkansas State Medical Board - Armedicalboard

Changing your address is an important task that should be done promptly to ensure that all communications from the Arkansas State Medical Board reach you without delay. This guide provides step-by-step instructions on how to accurately fill out the Change Of Address Form online, ensuring you provide all necessary information.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Change Of Address Form and open it in an online editor.
2. In the 'Practitioner Information' section, input your full name, including last name, first name, middle name, suffix, and any degrees. Make sure your Arkansas license number is also included.
3. Fill out the 'Public Address' section. This is the address that will appear publicly. Enter your street address or P.O. Box, suite/room/apartment number, city, state, ZIP code, country (if foreign), phone number, and fax number.
4. Complete the 'Private Address' section. This address is confidential and will be used solely by the Arkansas State Medical Board. Similar to the public address, provide your street address or P.O. Box, suite/room/apartment number, city, fax number, state, ZIP code, country (if foreign), and include your personal email address.
5. Sign the form where indicated, making sure to provide a handwritten signature—rubber stamps are not accepted. Also, input the date when you sign the form.
6. Once all sections are completed and reviewed for accuracy, save your changes. You have the option to download, print, or share the filled-out form as needed.

Ensure your address is up to date by filling out the Change Of Address Form online today!