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

Name Change & Duplication Request Form
Address - Employment Change Form

Supervision Form for OTA's
Supervision Form for PAM's Certification
Report of Required Professional Education in Physical Agent Modalities (PAMs)

Physical Therapists and Assistants

Supervision Form
Work History Report

Respiratory Care Practitioners

Supervision Form

Supervision Form for Provisional SLP

• Lists
  The Office of Licensed Allied Health Professionals provides lists for each profession. The cost of each list that is provided by e-mailed is $20.00 per profession and for a paper copy the cost is $25.00 per profession. Assistants are included in both the occupational therapy list and the physical therapy list. Send your written request to Office of licensed Allied Health Professionals, 2 Industrial Park Drive, Concord NH 03301, be sure to included your e-mail address if you are requesting the list be sent by e-mail. Include with your request a check in the appropriate amount made out to "Treasurer, State of NH".
• Labels
  If you are requesting labels the cost of the labels is $35.00 per profession and you provide the labels to be printed on. The labels you must provide are Avery 1" X 2 5/8" Laser 5160. Please contact the office before sending in your request to determine how many labels you will need to provide.

  Once your request is received at the Office of LIcensed Allied Health Professionals it takes approximately 1 week for lists and up to two weeks for labels.

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, 2 Industrial Park Drive, 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.