Orthotists and Prosthetists Forms

Practitioner License

License Application (PDF)

Occupational License Application Claiming to Have No Social Security Number

Assistant License

License Application (PDF)

Supervision Agreement (PDF)

Verification of Experience (PDF)

Student Registration

License Application (PDF)

Supervision Agreement (PDF)

Uniquely Qualified Person

License Application (PDF)

Professional Reference (PDF)

Attestation of Experience Providing Extensive Orthotic Care (PDF)

Attestation of Experience Providing Extensive Prosthetic Care (PDF)

Facility Accreditation

Facility Accreditation Application (PDF)

Change of On-Site Practitioner in Charge (PDF)

Change of Facility Safety Manager (PDF)

Facility Name Change and Duplicate License Request (PDF)

Other Forms

Change of Information or Duplicate License

Notice of Change and Duplicate License (PDF)

Expired License Renewal

Request to Executive Director for Expired License Renewal (PDF)

Disciplinary Action and Criminal History

Disciplinary Action Questionnaire (PDF)

Criminal History Questionnaire (PDF)

Criminal History Evaluation Letter

Misc. Forms

Military Service Member, Military Veteran, or Military Spouse Supplemental Application (PDF) - see Military Spouse Frequently Asked Questions

TDLR Complaint Sign (PDF)

Expert Witness Application

File Viewing Information

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Personal Information Collected

Please note the following policy regarding the filing of forms which collect a person's individual information:

"An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Department) is entitled to the following from the Department:

(1) to be informed about the information that the Department collects about the individual, upon the request of the individual and subject to a few exceptions;

(2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Government Code; and

(3) to have the Department correct information about the individual that is incorrect, under Section 559.004 of the Texas Government Code."