Board of Medical Examiners
Forms
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of a Military Member (PH-4280)
- Request for Duplicate License (PH-4058)
- Name and Address Change Request
- Affidavit of Retirement (PH-3460)
- Inactivation Form (PH-4270)
- Reporting of Convictions of Physicians
- Petition for Declaratory Order
- Request for Advisory Ruling
- Public Record Request Form
Applications for licensure as a Medical Doctor
► Applying for initial licensure from your professional licensing board has become a bit easier. The Department of Health has implemented an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application for Medical Doctor Licensure in Tennessee (Paper Application)
- Full Medical Doctor License Checklist and Forms
- Distinguished Faculty License Checklist and Forms
- Foreign Training License Checklist and Forms
- Graduate Physician License Checklist and Forms
- Locum Tenens License Checklist and Forms
- Short Term Clinical Visitor License Checklist and Forms
- Single Purpose License Checklist and Forms
- St. Jude License Checklist and Forms
- Temporary License Checklist and Forms
- Convert Limited License to Full Checklist
- Application for a Special Training License as a Medical Doctor (Paper Application)
- Application for Licensure Reinstatement
- Renewal Application
- Application for Special Volunteer License
- Application for Volunteer Health Care Services
Portability Act for Military and Military Spouse with transfer Orders to Tennessee
Please fill out the application below and email to Medical.Health@tn.gov with a copy of the military orders
Interstate Medical Licensure Compact
► The Interstate Medical Licensure Compact (IMLC) is an alternative pathway to medical licensure for physicians seeking to practice medicine in multiple states. The IMLC creates a streamlined process for obtaining multiple state licenses. Applicants for licensure through the IMLC must meet the rigorous qualifications for licensure which are established under the compact.
Tennessee is one of more than twenty states participating in the IMLC. For a complete list of participating states, minimum applicant qualifications, and information how to apply for licensure through the IMLC, please visit the Interstate Medical Licensure Compact Commission website at www.imlcc.org.
Office Based Surgery
- Office Based Surgery Level II & Level III Unanticipated Events Report (PH-4071)
- Application for Office Based Surgery (PH-3963)
Genetic Counselors
► Applying for initial licensure from your professional licensing board has become a bit easier. The Department of Health has implemented an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.