Skip to main content
  • State of Arizona
  • Visit OpenBooks
  • Ombudsman Citizens Aide
  • Register to Vote
Arizona State Veterinary Medical Examining Board Logo
Arizona State Veterinary Medical Examining Board
  • Home
  • About
    • Board Members
    • Staff
    • Agency Plans & Policies
    • FAQ
  • Complaints & Investigations
  • Licensing
    • Directory
    • Renewal
    • Premises
    • Animal Crematories
    • Registered Equine Dental Practitioners
    • Unlicensed Practitioners
  • News & Events
    • Meetings
    • Calendar
  • Statutes & Rules
  • Forms
  • Home
  • Forms

Forms

Veterinarians - Pathways to Licensure

AttachmentSize
PDF icon Veterinary Regular License Application Packet480.11 KB
PDF icon Veterinary License by Endorsement Application Packet477.32 KB
PDF icon Veterinary License by Universal Recognition614.91 KB
PDF icon Veterinary Specialty License Application Packet476.52 KB
PDF icon Faculty Member License Application Packet501.29 KB
PDF icon Active Duty Military & Spouses_SCRA Relocation to AZ due to military orders355.96 KB
PDF icon Veterinary State Employee Application Packet395.9 KB
PDF icon License Verification Request - Veterinarian118.44 KB
PDF icon Change of Address/Employment/Name99.73 KB
PDF icon Duplicate Wall License/Certificate Request Form171.5 KB

Certified Veterinary Technicians (CVT)

AttachmentSize
PDF icon CVT Application Packet - DO NOT USE UNLESS YOU HAVE PASSED THE VTNE629.42 KB
PDF icon CVT Universal Recognition Application (for Arizona residents who are licensed/certified in another state)392.47 KB
PDF icon CVT Address/Employment/Name Change Form186.8 KB
PDF icon CVT Certificate Verification Request (aka "letter of good standing")101.5 KB
PDF icon Duplicate Wall Certificate Request Form171.5 KB

Premises

AttachmentSize
PDF icon Premises License Application - Please do not submit more than 2 weeks prior to start of operations223.38 KB
PDF icon Premises Inspection Report (check-list)304.46 KB
PDF icon Notice of Inspection Rights147.43 KB
PDF icon Small Business Bill of Rights197.64 KB
PDF icon Anesthesia Log example26.33 KB
PDF icon Controlled Substance Dispensing/Administration Log example37.32 KB
PDF icon Controlled Substance Inventory Log example26.7 KB
PDF icon DEA Registered Reverse Distributor List - 8.24130.32 KB
PDF icon Premises Name Change / Change of Scope Request Form171.63 KB
PDF icon Duplicate Premises Wall License Request - Not needed for Renewal License pdf copy187.25 KB

Animal Crematories

AttachmentSize
PDF icon Animal Crematory Application & Instructions181.39 KB
PDF icon Animal Crematory Inspection Checklist232.17 KB
PDF icon Animal Crematory Name Change/Scope of Service Change Form79.03 KB

Complaints

AttachmentSize
PDF icon Complaint Investigation Form69.81 KB
PDF icon What to Expect After A Complaint Is Filed138.23 KB
PDF icon FAQs: Complaints & Investigations44.21 KB

Miscellaneous

AttachmentSize
PDF icon Public Records Reproduction Request Form144.44 KB
PDF icon Investigative Committee Volunteer Candidate Information Form126.54 KB

Registered Equine Dental Practitioners

AttachmentSize
PDF icon Equine Dental Practitioner Registration Form117.01 KB
PDF icon Equine Dental Practitioner Supervisor Form84.27 KB
PDF icon List of Registered Equine Dental Practitioners28.87 KB

Unlicensed Practitioners

AttachmentSize
PDF icon Unlicensed person providing veterinary care: Mario J. Cruz - Consent Agreement & Order637.1 KB
PDF icon Mario J. Cruz - Cease & Desist Order - Practicing without a license121.14 KB
PDF icon Kara Keller - Impersonating a veterinarian966.88 KB
PDF icon Landon Ames - Unlicensed person providing equine dental care114.33 KB
PDF icon Deva Khalsa, VMD - Practicing without an AZ license396.81 KB

2025 Spring/Summer Graduate Info

AttachmentSize
PDF icon Spring/Summer New Grad Information124.68 KB
Arizona State Seal
Contact Us
Arizona State Veterinary Medical Examining Board
1740 W Adams St
Phoenix, AZ 85007
Find in Google Maps
Phone: (602) 364-1-PET (1738)
Map Image

Footer Nav

  • Statewide Policies
  • Site Map