Home Public Record Public Record Text field Thank you for choosing to pay for your service with the Board’s online payment option. This form is to request a copy of an individual's license file. Please note: Only disciplinary outcomes will be considered public record. Fields marked with an asterisk* are required and must be completed prior to clicking Pay Now. Please enter applicant details as requested below: Customer Information First Name Middle Name Last Name Email @ Phone Number # Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Product Options Products Mailing List - $150 Meeting Audio - $20 (available on the Board's website as of January 1, 2019) Licensure File - $25 Other Electronic Records (Describe Below) - $25 The mailing list is available in Excel and contains only the public information for the active licensees (mailing address, license number and expiration date, NOT emails) The list will be emailed to you. Disciplinary action older than 5 years (pursuant to A.R.S. § 32-3214) Complaints dismissed with a non-disciplinary consent agreement older than 5 years (pursuant to A.R.S. § 32-3214) Complaints dismissed with a letter of concern Dismissed complaints License Number # Describe Records Requested Describe Records Below I acknowledge that pursuant to A.A.C. R4-6-215(C), application fees in subsections (A)(1) and (2) are non-refundable and other fees established in subsection (A) are not refundable unless the provisions of A.R.S. § 41-1077 apply. * * Payment Detail Preview Leave this field blank