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Board of Medicine Address
  Commonwealth of Massachusetts
  Board of Registration in Medicine
  200 Harvard Mill Square, Suite 330
  Wakefield, MA 01880
  (781) 876-8200
  (781) 876-8395 (TTY)
  Hours M-F; 8:45 a.m. to 5:00 p.m.

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Home > Physician Information > Full License Applications

Downloadable Application
Kits for
Full License

(Not Renewal)

Applicants for full licensure in Massachusetts may download any or all of the following forms for use in preparing their application.

This is only for initial full licensure...not for renewal of a full license.

All forms are Adobe Portable Document Format (PDF) files. You must have the Adobe Acrobat Reader Plugin for your browser in order to download and use these forms. Acrobat Reader is a free download from Adobe. It can be obtained by clicking on this link. First download the reader, then run the installation program to add the plugin to your browser.

Please read the instructions carefully before completing your application.

Full License Documents

Full License Application Kit Adobe Acrobat Document
Letter to Applicant Adobe Acrobat Document
Requirements for Full Licensure Adobe Acrobat Document
Application Instruction Booklet Adobe Acrobat Document
Application Checklist Adobe Acrobat Document
Full License Application Form Adobe Acrobat Document
Medicare Tax Form Adobe Acrobat Document
Moral & Professional Character Adobe Acrobat Document
Authorization for Release Adobe Acrobat Document
Full License Supplement Adobe Acrobat Document
Medical Education Verification Adobe Acrobat Document
Postgraduate Training Verification Adobe Acrobat Document
Evaluation Form Adobe Acrobat Document
State License Verification Adobe Acrobat Document
Malpractice History Form Adobe Acrobat Document
AMA Profile Request Form Adobe Acrobat Document
NPDB Profile Instructions Adobe Acrobat Document
Name Change Form Adobe Acrobat Document
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