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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 Packet483.18 KB
PDF icon Veterinary Endorsement License Application Packet406.94 KB
PDF icon Veterinary License by Universal Recognition503.9 KB
PDF icon Veterinary Specialty License Application Packet631.66 KB
PDF icon Faculty Member License Application Packet555.01 KB
PDF icon Veterinary State Employee Application Packet399.14 KB
PDF icon License Verification Request - Veterinarian117.9 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 431.39 KB
PDF icon CVT Universal Recognition Application (for Arizona residents who are licensed/certified in another state)367.2 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)301.73 KB
PDF icon Notice of Inspection Rights147.43 KB
PDF icon Small Business Bill of Rights110.68 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 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 Checklist257.83 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 Form161.13 KB
PDF icon Investigative Committee Volunteer Candidate Information Form129 KB

Registered Equine Dental Practitioners

AttachmentSize
PDF icon Equine Dental Practitioner Registration Form108.99 KB
PDF icon Equine Dental Practitioner Supervisor Form84.27 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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