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Forms & Documents


Electronic Forms

Request an Application

  • When requesting an application for Respiratory Care Practitioner use the credentials RCP
  • When requesting an application for Recreational Therapist use the credentials RT

Change your Employer Address
Change your Home Address

FORM LINE DESCRIPTIONS:

These documents are designed to assist you in filling out the various forms required for submission by the Office of Licensed Allied Health Professinals. These documents do not replace the requirements set forth in the Administrative Rules which govern your profession.

2013 Renewal Form Line Description Microsoft Word Symbol
Supervision Form Line DescriptionMicrosoft Word Symbol

FORMS:

General Forms:

Name Change & Duplication Request Form Adobe Acrobat Reader Symbol
Address - Employment Change Form Adobe Acrobat Reader Symbol

Athletic Trainers

Occupational Therapists and Assistants

Supervision Form for OTA'sMicrosoft Word Symbol
Supervision Form for PAM's CertificationMicrosoft Word Symbol
Report of Required Professional Education in Physical Agent Modalities (PAMs) Microsoft Word Symbol

Physical Therapists and Assistants

Supervision Form Microsoft Word Symbol
Work History ReportMicrosoft Word Symbol

Recreational Therapists

Respiratory Care Practitioners

Supervision FormMicrosoft Word Symbol

Speech-Language Pathologists

Supervision Form for Provisional SLP Microsoft Word Symbol

Lists, Labels, and Verifications for All Professions

Verification of Licensure for all Professions

To obtain a letter of verification from the Office of Licensed Allied Health Professionals send a written request and a check in the amount of $25.00 made payable to "Treasurer, State of NH" to the Office of LIcensed Allied Health Professionals, 121 South Fruit Street, Concord NH 03301. Make sure to include the name and address of where you would like the verification sent. ALL REQUESTS MUST BE SIGNED BY THE LICENSEE REQUESTING THE VERIFICATION.

Once your request is received at the Office of LIcensed Allied Health Professionals it takes approximately 1 week to process.

Microsoft Word Symbol Microsoft Word format. You can download a free viewer from Microsoft.

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.


copyright 2008. State of New Hampshire