Maryland Board of Physicians

Allied Health Applications

Important Notice about the Licensure Process

Please note: All forms are fillable.

Consistent with the Americans with Disabilities Act (ADA) Title II final rule, individuals are entitled to request an accessible version of any electronic document presented on this website. Please contact mbpmail@rcn.com with the name of the document, the desired file type (MS Word, PDF, etc.), and the accommodation needed. The requested file will be provided promptly. It is possible that some requests may take longer due to the size, complexity, or the graphical nature of the respective document.

For additional information, please contact the IT Accessiblity Specialist with any questions or concerns about this process.

Criminal Background checks are required as of October 1, 2016.

The Board of Physicians will not accept outdated applications. If you submit your application on an outdated form, it will be returned to you and will delay the processing of your application.

AH Licensure Applications and Reinstatements

Online Initial Licensure for Athletic Trainers

Effective May 1, 2023, the Board will no longer accept the paper initial license application form for Athletic Trainers.

Online Reinstatement for Athletic Trainers

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Athletic Trainers.

Verification of Professional Education

AT Supplemental Form

Verification of Other State Licenses

AT Supplemental Form

Alternate Supervising Physician Designation

Evaluation and Treatment Protocol

Dry Needling Specialized Task Application

Board-Approved DN: Changing Supervising Physician

Termination of Evaluation and Treatment Protocols must be done within the Practitioner Profile.

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Genetic Counselors

Effective 10/23/2023, Online Licensure is available for Genetic Counselors and Supervised Genetic Counselors.

Online Reinstatement for Genetic Counselors

Genetic Counselor

Verification of Education

GC Supplemental Form

Verification of Other State Licenses

GC Supplemental Form

Supervised Genetic Counselor

Verification of Education

SGC Supplemental Form

Verification of Other State Licenses

SGC Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Registration for Limited X-Ray Machine Operator

Online Reinstatement for Limited X-Ray Machine Operator

Verification of Other State Licenses

LXMO Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Naturopathic Doctors

Effective May 29, 2023, the Board will no longer accept the paper initial license application form for Naturopathic Doctors.

Online Reinstatement for Naturopathic Doctors

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Naturopathic Doctors.

Verification of Professional Education

ND Supplemental Form

Verification of Other State Licenses

ND Supplemental Form

Initial Licensure by Reciprocity

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Nuclear Medicine Technologists

Effective 12/04/2023, the Board will no longer accept the paper initial license application form for Nuclear Medicine Technologists.

Online Reinstatement for Nuclear Medicine Technologists

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Nuclear Medicine Technologists.

Verification of Education

NMT Supplemental Form

Verification of Other State Licenses

NMT Supplemental Form

Notification of Intent To Perform Diagnostic CT

Instructions and form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Initial Licensure

Online Reinstatement for Perfusionists

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Perfusionists.

Verification of Other State Licenses

CCP Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Physician Assistants

Effective May 1, 2024, the Board will no longer accept the paper initial license application form for Physician Assistants.

Online Expedited Licensure For Physician Assistants

Effective Aug 15, 2024, eligible Physician Assistants may apply for Endorsement or Reciprocity.

Online Reinstatement for Physician Assistants

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Physician Assistants.

Verification of Education

PA Supplemental Form

Verification of Other State Licenses

PA Supplemental Form

Notification of Collaboration Agreement

Online Version Must be initiated by the physician assistant via his/her editable Practitioner Profile. To begin, click to login to your Practitioner Profile.

Instructional PDF demo

Collaboration Agreement Forms

Collaboration Agreement Sample

Sample References: 1 ❘ 2 ❘ 3

Addendum for Advanced Duties

Collaboration Agreement Terminations must be done within the Practitioner Profile.

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Initial Licensure

Online Reinstatement for Polysomnographic Technologists

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Polysomnographic Technologists.

Verification of Education

PSGT Supplemental Form

Verification of Other State Licenses

PSGT Supplemental Form

Clinical Hrs & Core Competencies

Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Radiation Therapists

Effective 06/01/2024, the Board will no longer accept the paper initial license application form for Radiation Therapists.

Online Reinstatement for Radiation Therapists

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Radiation Therapists.

Verification of Education

RT Supplemental Form

Verification of Other State Licenses

RT Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Radiographers

Effective 12/30/2024, the Board will no longer accept the paper initial license application form for Radiographers.

Online Reinstatement for Radiographers

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Radiographers.

Verification of Education

RTR Supplemental Form

Verification of Other State Licenses

RTR Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Initial Licensure

Online Reinstatement for Radiologist Assistants

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Radiologist Assistants.

Verification of Other State Licenses

RRA Supplemental Form

Advanced Procedures Request

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Online Initial Licensure for Respiratory Care Practitioners

Effective 12/16/2024, the Board will no longer accept the paper initial license application form for Respiratory Care Practitioners.

Online Reinstatement for Respiratory Care Practitioners

Effective March 1, 2025, the Board will no longer accept the paper reinstatement application form for Respiratory Care Practitioners.

Verification of Education

RCP Supplemental Form

Verification of Other State Licenses

RCP Supplemental Form

If you have any questions about the application process or have a question that does not appear in the FAQs, please email the Board at mbpmail@rcn.com.

Maryland Board of Physicians

Allied Health Applications

AH Licensure Applications and Reinstatements

Resources