Podiatry

Podiatry Forms

On this page:

Podiatric Physician
Podiatric Medical Radiological Technician
Podiatric Practices
Other Forms

Part II CSPE exam requirement is waived for 2021-2025 podiatry school graduates who apply for a residency license.

Virtual CPR course accepted for current license applicants.

Podiatric Physician

Full License

Title	Form Number
Doctor of Podiatric Medicine License Application (PDF)	POD-LIC-001
Memorandum of Understanding for Conditional Issuance of Texas Doctor of Podiatric Medicine License (PDF) For third year residents transitioning to full DPM Licensure	POD-LIC-001A
Hyperbaric Oxygen (HBO) Permit Application (PDF)	POD-LIC-003
Nitrous Oxide/Oxygen (N2O) Inhalation Conscious Sedation Permit Application (PDF)	POD-LIC-004
Podiatry Duplicate License/Certificate/Permit Request and Change of Information Form (PDF)	POD-LIC-010
Voluntary Charity Care Affidavit (PDF)	POD-LIC-011
License Inactive Status Request Form for Doctor of Podiatric Medicine (PDF)	POD-LIC-012
Liability Claims Report for Podiatry Medical Professionals (PDF)	POD-LIC-013

Limited Faculty License

Title	Form Number
Doctor of Podiatric Medicine Limited Faculty License Application (PDF)	POD-LIC-015

Residency License

Title	Form Number
Application for Residency License (PDF) Only required if sending a paper application by mail.	POD-LIC-006
Memorandum of Understanding for Approved Residency Program (PDF) Required for first year applicants only - attach to online application.	POD-LIC-006A
Certificate Of Acceptance For Postgraduate Training Program (PDF) Required every year - attach to online application and renewal.	POD-LIC-006B
Memorandum of Understanding (MOU) for Conditional Issuance of a Temporary Residency License (PDF)	POD-LIC-007

Provisional License

Title	Form Number
Application for Provisional License (PDF)	POD008

Podiatric Medical Radiological Technician

Title	Form Number
Podiatric Medical Assistant Radiological Technician Application (PDF)	POD-LIC-009-E

Podiatric Practices

Title	Form Number
Electronic Prescribing Waiver Form (PDF)	POD-LIC-014
TDLR Complaint Sign (PDF)	LIC009

Insurance plan complaints and information: Texas Department of Insurance - Physicians & Health Providers

Texas Medical Disclosure Panel - Rules and Forms related to Informed Consent. The Texas Medical Disclosure Panel publishes Rules and Forms related to "Informed Consent" under Title 25, Texas Administrative Code, Part 7, Chapter 601.

Other Forms

Title	Form Number
Criminal History Evaluation Letter	ENF001
Disciplinary Action Questionnaire (PDF)	ENF002
Criminal History Questionnaire (PDF)	LIC002
Request to Executive Director for Expired License Renewal (PDF)	LIC003
Expert Witness Application	N/A
Social Security Number Status Certification	LIC-017
Military Service Member, Military Veteran, or Military Spouse Supplemental Application (PDF)	MIL-LIC-001-E
Voluntary License Surrender Form (PDF)	LIC-018