Texas Board of Licensure for Professional Medical Physicists Application-Forms

Select the link below for the complete application/form for Licensed Medical Physicists:

• Application for Licensure as a Professional Medical Physicist (MS Word format, 140 KB)
• Application for Licensure as a Professional Medical Physicist (Adobe Acrobat format, 66 KB)

• Renewal Form for Medical Physicist (Word format, 65 KB)
• Renewal Form for Medical Physicist (Adobe Acrobat format, 28 KB)
  
  
• Temporary Licensed Medical Physicist renewal form (Word format, 99 KB)
• Temporary Licensed Medical Physicist renewal form (Adobe Acrobat format, 68 KB)

• Application to Upgrade Temporary License (MS Word format, 94 KB)
• Application to Upgrade Temporary License (Adobe Acrobat format, 73 KB)

• Specialty Affidavit Form (Form D) (MSWord format, 21KB)
• Specialty Affidavit Form (Form D) ( Adobe Acrobat format, 13KB)

• Self-Employment Affidavit Form (Form E) (MSWord format, 23KB)
• Self-Employment Affidavit Form (Form E) ( Adobe Acrobat format, 13KB)
  

• Professional Experience Form (Word format, 38 KB)
• Professional Experience Form (Adobe Acrobat format, 16 KB)
  
  
• Professional Reference Form (Word format, 45 KB)
• Professional Reference Form (Adobe Acrobat format, 25 KB)
  
  
• Agreement of Supervision Form (MSWord format, 67 KB)
• Agreement of Supervision Form (Adobe Acrobat format, 47 KB)
  

• Verification of Licensure (Word format, 37 KB)
• Verification of Licensure (Adobe Acrobat format, 10 KB)
  
  
• Download a copy of the complaint form and instructions

To access documents in Adobe Acrobat format, you must download the Acrobat Reader software. Please see the DSHS file viewing page for more information and a link to the Adobe website.