Physician and Surgeon
Additional Forms
- Electronic Prescriptions for Controlled Substances: Request for Limited Extension to Comply
- Controlled Substance Application Form
- Designation of Contact Form
- Tax Credit Attestation: New Utah Practice
- Tax Credit Attestation: Underserved
- Tax Credit Attestation: Volunteer Retired Psychiatrist
- Inactive Licensure Application
- Volunteer Health Care Practitioner
- Volunteer Delegation of Services Agreement (DOSA)
- Request to Remove Controlled Substance License
- Restricted Associate Physician Collaborative Practice Agreement
- Transgender Treatment Certification
