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Arizona State Veterinary Medical Examining Board
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Forms

Veterinarians - Pathways to Licensure

AttachmentSize
PDF icon Veterinary Regular License Application Packet492.65 KB
PDF icon Veterinary License by Endorsement Application Packet420.78 KB
PDF icon Veterinary License by Universal Recognition523.37 KB
PDF icon Veterinary Specialty License Application Packet487.09 KB
PDF icon Faculty Member License Application Packet555.01 KB
PDF icon Veterinary State Employee Application Packet399.14 KB
PDF icon License Verification Request - Veterinarian - $15 Fee reinstated as of August 1, 2021119.52 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 VTNE 434.56 KB
PDF icon CVT Universal Recognition Application (for Arizona residents who are licensed/certified in another state)437.02 KB
PDF icon CVT Address/Employment/Name Change Form187.81 KB
PDF icon CVT Certificate Verification Request (aka "letter of good standing")106.09 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 operations226.78 KB
PDF icon Premises Inspection Report (check-list)450.53 KB
PDF icon Notice of Inspection Rights147.43 KB
PDF icon Small Business Bill of Rights119.19 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 - 8/2020259.45 KB
PDF icon Premises Name Change/ Change of Scope Request Form144.78 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 & Instructions180.97 KB
PDF icon Animal Crematory Inspection Checklist229.99 KB
PDF icon Animal Crematory Name Change/Scope of Service Change Form69.09 KB

Complaints

AttachmentSize
PDF icon Complaint Investigation Form68.93 KB
PDF icon What to Expect After A Complaint is Filed134.4 KB
PDF icon FAQs: Complaints & Investigations44.21 KB

Miscellaneous

AttachmentSize
PDF icon Public Records Reproduction Request Form161.13 KB
PDF icon Investigative Committee Volunteer Candidate Information Form125.02 KB

Registered Equine Dental Practitioners

AttachmentSize
PDF icon Equine Dental Practitioner Registration Form145.61 KB
PDF icon Equine Dental Practitioner Supervisor Form72.43 KB
PDF icon List of Registered Equine Dental Practitioners28.48 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
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)
Fax: (602) 364-1039
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