Get Physical Therapy Board Of California - Request For Authorization To Practice Without A California
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Physical Therapy Board Of California - Request For Authorization To Practice Without A California online
This guide provides clear and comprehensive instructions for filling out the Physical Therapy Board of California's Request for Authorization to Practice Without a California License. It is designed to assist users, regardless of their legal experience, in navigating the form accurately and efficiently.
Follow the steps to complete the request form effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part A, provide your name, Social Security number, date of birth, and contact information. Ensure all information is accurate and complete.
- Input the name and details of your employer in the respective fields of Part A, including their contact information.
- List the name and location of the physical therapy school from which you graduated in Part A.
- Indicate whether you passed a physical therapy licensure examination, and provide details including the name of the examination and the date it was taken in Part A.
- In Part B, answer whether you hold a current valid and active license. If yes, provide details of all relevant licenses, including the state, issuing agency, license number, and expiration date.
- Answer the questions related to any past revocations or disciplinary actions regarding your license in Part B.
- Complete Part C by providing the name and address of the sponsoring entity, along with the name of the event, dates and locations of the event, and any healthcare services you intend to provide.
- In Part D, acknowledge and certify that all information provided is true, and sign the form, including the date and your printed name.
- Finally, ensure you attach all required documentation such as payment, photo identification, copies of licenses, verification of licensure, and fingerprints as outlined in the instructions. You can save changes to the form, download it, print it, or share it as needed.
Complete your authorization request online today and ensure you meet all requirements for participating in the health care event.
The direct access physical therapy law in California was passed in 2013. This significant legislation allows patients to seek treatment from physical therapists without a prior referral. Knowing the timeline, such as the changes outlined by the Physical Therapy Board Of California - Request For Authorization To Practice Without A California, can help individuals understand their rights and options in therapy.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.