Board of Physical Therapy & Occupational Therapy

Applications & Forms

License Applications

Renewal Applications

Renewal Applications for Physical Therapy and Occupational Therapy were mailed on May 16, 2014 from Juneau, AK. They were mailed to the address on your license as of April 1, 2014. If you do not have a current forwarding address on file with the USPS, your mail will be returned to our office. We encourage you to use the renewal application mailed to you as this is barcoded specifically to your license and will expedite the application process once received in our building. If you did not receive your renewal application, use the links below to download the appropriate form:

If you renewed your license for the renewal period of July 1, 2012 to June 30, 2014 after April 1, 2014 you will not receive a renewal application in the mail. Use the links above to download the appropriate form.

Thank you for your patience in the renewal process. Please plan accordingly, review your renewal application prior to returning to our office to make sure all areas are fully complete and submit your renewal application early to allow processing time in our agency.

If your license lapsed on June 30, 2012 and you would like to renew your license for July 1, 2012 to June 30, 2014 license period send an email to connie.petz@alaska.gov, provide the name the license was under and the license number. You will then be emailed the correct application for renewal. If your license is not renewed by June 30, 2014 you are required to complete a reinstatement application and meet the requirements according to 12 AAC 54.950. REINSTATEMENT OF A LAPSED LICENSE.

Reinstatement Applications

Miscellaneous Forms