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

All initial license applications must be submitted through BreEZe Online Services. Effective March 1, 2025, the Board will no longer accept and process, the following forms received via email. These documents must be submitted online through BreEZe Online Services. They may be attached to either the initial license application or the "Initial License Application — Additional Documentation" application. Applicants may use the "Initial License Application — Additional Documentation" application in BreEZe to submit documents to the Board after submission of the initial license application.

• Explanation for Application Questions (Form EXP)
• Timeline of Activities (Form TOA)
• Completed Request for Live Scan Services form
• Name Change Documentation
• Priority Review and Expedite documentation
• Supporting identification documents, such as SSN/ITIN and Identification cards

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

• Initial License Renewal Verification of ACGME/RCPSC/CFPC Postgraduate Training (Form ILR)
• 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 (Midwives), for Midwives applicants only

Polysomnography

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

Research / Student Research Psychoanalysts

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