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Forms

 

Forms for physicians:

 

Licensure Application Documents

Affidavit For Surrender of License

Change of Address Form (try to change address online first)

Request for Name Change

Rules Regarding Medical Records

Fee Schedule

How to Close an Osteopathic Physician's Office

Monthly Supervision Self Report

Practice Codes and Specialty Codes

Renewal Questions(Contact Board prior to use)

Request Form for License Verifications, Directory, Letters of Good Standing, Secretary of State Letters, Licensure Files, & Disciplinary Files.

Volunteer License Application (Retired Physicians)

E-Prescribing Waiver Form

Compliance Information Request

 

 

Forms for the public:

 

Fee Schedule for charges associated with license and records requests.

Practice or Specialty Codes for physician's practice code or specialty code as listed on the physician search.

Medical Records- Statute Regarding Patient Access to Medical Records.

Request Form for License Verifications, Directory, Letters of Good Standing, Secretary of State letters, Licensure Files, & Disciplinary Files.

To report a D.O. if The Oklahoma Osteopathic Medicine Act has been violated:

File an Online Complaint

Complaint Form Fillable or Handwritten*

*You may print and mail the above form to: OSBOE, 4848 N. Lincoln Blvd.,Suite 100,  Oklahoma City, OK  73105, email it to Investigations@osboe.ok.gov, or fax it to (405) 557-0653.