Physician's & Surgeon's License - Apply By Mail

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• Postgraduate Training License (PTL) Application Forms [+]
  • Application for a Postgraduate Training License Information & Checklist
  • Application for a Postgraduate Training License (Forms PTL1-PTL5)
  • Live Scan Service Form for Electronic Fingerprints
  • Explanation for Application Question (Form EXP)
  • Timeline of Activities (Form TOA)
  • Certificate of Medical Education (Form MED)
  • Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA/B)
  • Postgraduate Training License Enrollment Form (Form EF)
• Physician's and Surgeon's License Application Forms [+]
  • Application for a Physician and Surgeon License Information & Checklist
  • Application for a Physician and Surgeon License (Forms L1A-L1F)
  • Live Scan Service Form for Electronic Fingerprints
  • Explanation for Application Question (Form EXP)
  • Timeline of Activities (Form TOA)
  • Certificate of Medical Education (Form MED)
  • Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA/B)
  • Current Postgraduate Training Verification (Form CTV)
  • Limited Practice License (Form LPL), if applying for Limited Practice status
  • Certificate of Completion of CODA Postgraduate Training (Form CODA1-CODA2)
• Transition from a Postgraduate Training License (PTL) to a Physician’s and Surgeon’s License Application Forms (PTL Holders Only) [+]
  • Application to Transition from a PTL to a Physician’s and Surgeon’s License Information & Checklist
  • Application to Transition from a PTL to a Physician’s and Surgeon’s License (Forms TF1-TF4)
  • Live Scan Service Form for Electronic Fingerprints
  • Explanation for Application Question (Form EXP)
  • Certificate of Medical Education (Form MED)
  • Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA/B)
  • Current Postgraduate Training License Enrollment Form (Form CTV)
  • Limited Practice License (Form LPL), if applying for Limited Practice status
  • Certificate of Completion of CODA Postgraduate Training

Other Forms and Information

• Notarized Signatory Page (Form L1F), Required for Physician's and Surgeon's License Applications submitted using the BreEZe online application system
• Notarized Signatory Page (Form TF4), Required for Transition Applications submitted using the BreEZe online application system
• Notarized Signatory Page (Form PTL5), Required for PTL Applications submitted using the BreEZe online application system
• Program Status Update/Change (Form PSU)
• Translation of International Academic Credentials
• Notification of Name Change
• Applicant Address Change Request
• Fictitious Name Permit Application

Attention: Osteopathic Physicians and Surgeons

Do not complete this application packet if you are applying for licensure as an osteopathic physician and surgeon. Please contact the Osteopathic Medical Board of California at (916) 928-8390 for an application and further information.