Resources

Forms

Below are all forms used by the Medical Board of California. If you need assistance filling them out, contact our Consumer Information Unit at (916) 263-2382.

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Applicants

In an effort to move to a paperless application process, the Board removed Application for a Postgraduate Training License (Forms PTL1-PTL4) and Application to Transition from a Postgraduate Training License to a Physician’s and Surgeon’s License (Form TF1-TF3).

Effective February 1, 2023, the Board will no longer accept, and process, the following paper applications, as they must be submitted online through BreEZe Online Services:

• Application for a Postgraduate Training License (Forms PTL1-PTL4)
• Application to Transition from a Postgraduate Training License to a Physician’s and Surgeon’s License (Form TF1-TF3)

• Physicians and Surgeons

  • Postgraduate Training License (PTL) Application Forms

    • Application for a Postgraduate Training License Information & Checklist
    • Request for 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-PTB)
    • Research During Training Questionnaire (Form RES1-RES2)
    • Postgraduate Training License Enrollment Form (Form EF)

  • Physician's and Surgeon's License Application Forms

    • Application for a Physician's and Surgeon's License Information & Checklist
    • Request for 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-PTB)
    • Certificate of Completion of CODA Postgraduate Training (Form CODA1-CODA2)
    • Current Postgraduate Training Verification (Form CTV)
    • Limited Practice License (Form LPL), if applying for Limited Practice status

  • 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 Postgraduate Training License to a Physician’s and Surgeon’s License Information & Checklist
    • Explanation for Application Question (Form EXP)
    • Certificate of Medical Education (Form MED)
    • Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA-PTB)
    • Current Postgraduate Training Verification (Form CTV)
    • Limited Practice License (Form LPL), if applying for Limited Practice status

  • Other Forms and Information

    • Program Status Update/Change (Form PSU1-PSU2)
    • Translation of International Academic Credentials
    • Notification of Name Change
    • Applicant Address Change Request
    • Fictitious Name Permit Application and Checklist
    • Direct Online Certification Submission (DOCS) Flyer and Form, for use by medical school or program officials only

  • Physician’s and Surgeon’s Initial License Renewal Forms

    • Certificate of Completion of ACGME/RCPSC/CFPC Postgraduate Training (Form PTA-PTB)
    • Certificate of Completion of CODA Postgraduate Training (Form CODA1-CODA2)
    • Research During Training Questionnaire (Form RES1-RES2)

• Midwives

  • Application for Midwifery License
  • Live Scan Service Form for Electronic Fingerprints, for Midwives applicants only

• Polysomnography

  • Application for Polysomnography Registration
  • Live Scan Service Form for Electronic Fingerprints, for Polysomnography applicants only

• Research / Student Research Psychoanalysts

  • Application for Research/Student Research Psychoanalyst
  • Live Scan Service Form for Electronic Fingerprints, for Research/Student Research Psychoanalysts applicants only