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.

Tips for Viewing and Using Fillable PDFs

Licensees

• Notice of Change of Address/Email
• Notification of Name Change

• Physicians and Surgeons

  • Application for Cancellation of a Fictitious Name Permit
  • Application for Waiver of Continuing Medical Education During Renewal Cycle
  • Application for Duplicate Certificate
  • Application for Duplicate Fictitious Name Permit
  • Application for Inactive License
  • Application for Voluntary Surrender of License
  • Application to Restore License to Full, Active Status from Inactive, Disabled or Fee Exempt Status or from Disabled Status to Active Status with Limitations on Practice
  • Armed Forces Personnel Application for Exemption from Payment of Renewal Fee
  • Disabled Physician Application for Exemption from Payment of Renewal Fee
  • Fictitious Name Permit Application
  • Fictitious Name Permit Change of Address Form
  • Fictitious Name Permit Notification of Partnership Change
  • Fictitious Name Permit Notification of Shareholder Change
  • Fictitious Name Permit Notification of Renewal/Hold Release
  • Petition for Penalty Relief
  • Physician Orders for Life Sustaining Treatment (POLST) form
  • Retired Physician Application for Exemption from Payment of Renewal Fee - No Practice Allowed
  • Voluntary Service Physician Application for Waiver from Payment of Initial License or Renewal Fee

• Midwives

  • Licensed Midwife Disclosure Form
  • Midwife Application for Inactive License
  • Midwife Application to Restore License to Full, Active Status from Inactive or Retired Status
  • Retired Midwife Application for Exemption from Payment of Renewal Fee - No Practice Allowed
  • Transfer of Planned Out-of-Hospital Delivery to Hospital Reporting Form