Written verification of licensure

To request a hard-copy license verification with the Medical Licensure Commission seal affixed, please use our written verification request form

If you are applying to another state, and there is a form in that application packet for verification of other state licenses, please provide the form by mail, fax or
Failure to include this form could delay the provision of complete information.

If there is no form provided by the other state, please fill in, execute, and send the release form by mail, fax or  

We will prepare the form and mail it to the address you indicate on the request form.

There is no charge for this service.

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