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Vital Records & Statistics
FEMA COVID-19 Funeral Assistance Program
Women, Infants, and Children
More WIC Information
Nutrition Information
Infant and Toddlers Program
Hamburger Toggle Menu
Family Planning Clinics
Maternal and Child Health
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How To Obtain A Health Card
Public Health Preparedness
Office of Professional Licensure and Health Planning
Hamburger Toggle Menu
Emergency Medical Services
Epidemiology & Disease Reporting
Community Health Services
Primary Care
Vector Control Program Projects
Dengue, Zika, and Chikungunya
Dengue Fever
Personal Protection
You Can Help with Mosquito Control!
Contact Us!
Hamburger Toggle Menu
News & Events
Close News & Events
Open News & Events
News
Upcoming Events
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Hurricanes
Hurricane Season: Are You Ready?
Before a Hurricane
Preparing for a Hurricane: Prescriptions
Preparing for a Hurricane or Tropical Storm
During a Hurricane
Get your family, home, and car ready
Household Cleaning & Sanitizing
Mosquitoes & Hurricanes
Protect Your Pets
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Safe Haven – A Lead-Free Families Initiative
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Payments
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Office of Professional Licensure and Health Planning
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Payments
Licensure and Health Planning Payment Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Licensee / Facility Name
License Type
*
(DC) - Chiropractic
(DDS, DMD) - Dentistry
(RDH) - Dental Hygienist
(MD, DO) - Medicine and Surgery
(PA, PA-C) - Physician Assistant
(PSY, PSYD, MA Psych Assoc.) - Psychologist
(RPH, PharmD) - Pharmacist
(CPTI, CPT, RPT, PPT) - Pharmacy Technician
(SRX) - Non-Resident Pharmacy
(CTO, OD) - Optometry
(PT, DPT) - Physical Therapy
(PTA) - Physical Therapy Assistant
(DPM) - Podiatry
(DVM) - Veterinary Medicine
(RVT) - Veterinary Technician
(RRT) - Radiology Technician
(CON) - Certificate Need Pharmacy
(ND, OT, MT) - Allied Health Clearance Letter
Other
Other License Type
License Number
(If Applicable)
File Upload
Click or drag a file to this area to upload.
Payment for:
Certificate of Need - Service
Certificate of Need - Facility
Chiropractic - Application
Chiropractic - Registration
Dental (DDS, DMD) - Registration
Dental (RDH) - Registration
Medical MD/DO - Registration
Medical PA-C - Registration
Optometry - Application
Optometry - Registration
Pharmacist - Application
Pharmacist - Registration
Pharmacy - New
Pharmacy - Change in "Person in Charge"
Pharmacy - Change of Ownership
Pharmacy - Remodeling of Prescription Department
Pharmacy - Non-Resident Pharmacy (Initial)
Pharmacy - Non-Resident Pharmacy (Renewal)
Pharmacy Technician - Certified Pharmacy Technician (CPT)
Pharmacy Technician - Certified Pharmacy Technician w/ Immunization (CPTI)
Pharmacy Technician - Registered Pharmacy Technician (RPT)
Physical Therapy (DPT, PT) - Application
Physical Therapy (DPT, PT) - Registration
Physical Therapy (PTA) - Application
Physical Therapy (PTA) - Registration
Podiatry (PDM) - Application
Podiatry (PDM) - Registration
Veterinary (DVM) - Application
Veterinary (DVM) - Registration
Veterinary Technician - Application
Veterinary Technician - Registration
Fee(s)
*
Minimum Price: $15.00
Billing Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
--- Select country ---
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
Antarctica
Antigua and Barbuda
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Armenia
Aruba
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Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
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Central African Republic
Chad
Chile
China
Christmas Island
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Colombia
Comoros
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Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
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Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
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Faroe Islands
Fiji
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French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
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Ghana
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Greenland
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Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
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Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
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Jordan
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Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
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Liberia
Libya
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Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
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Niger
Nigeria
Niue
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Northern Mariana Islands
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Papua New Guinea
Paraguay
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Pitcairn
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Portugal
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Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
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Saint Pierre and Miquelon
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Samoa
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Sao Tome and Principe
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Senegal
Serbia
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Slovakia
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Credit Card
*
Card Number
MM
1
2
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Expiration
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YY
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Security Code
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