Get State Verification Form For Md, Do, Dc, Dpm - Kansas State Board Of ...

Filling out the State Verification Form is a crucial step in verifying your professional license with the Kansas State Board of Healing Arts. This guide will help you navigate each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to fill out the State Verification Form online.

1. Click ‘Get Form’ button to access the verification form and open it in your preferred document editor.
2. Enter your full name in the designated field. If you have used other names, please include them in the 'Other Names Used' section.
3. Input your license or registration number in the specified area. This number is essential for the verification process.
4. Provide your date of birth by filling in the day, month, and year in the corresponding fields.
5. Fill out the issue date of your license or registration in the designated fields.
6. Select your profession from the 'Profession' drop-down menu or list.
7. In the authorization section, indicate the agency that will receive your verification by entering the necessary details such as 'Agency', 'Address', 'City', 'State', and 'Zip'.
8. Sign and date the form at the bottom. Your signature serves as authorization for the Kansas Board of Healing Arts to release your verification information.
9. Once you have completed all fields, review your information for accuracy. After ensuring all data is correct, you can save the document, download it, or print it for submission.
10. To complete your verification request, you may need to submit payment via check, money order, or credit card. If using a credit card, complete the Credit Card Payment Authorization form and sign and date it as well.

Complete your State Verification Form online today to ensure a smooth verification process.