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 podiatry school graduates who apply for a temporary 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-E
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-E
Hyperbaric Oxygen (HBO) Permit Application (PDF)	POD003
Nitrous Oxide/Oxygen (N2O) Inhalation Conscious Sedation Permit Application (PDF)	POD004
Podiatry Duplicate License/Certificate/Permit Request and Change of Information Form (PDF)	POD010
Voluntary Charity Care Affidavit (PDF)	POD011
License Inactive Status Request Form for Doctor of Podiatric Medicine (PDF)	POD012
Liability Claims Report for Podiatry Medical Professionals (PDF)	POD013

Limited Faculty License

Title	Form Number
Doctor of Podiatric Medicine Limited Faculty License Application (PDF)	POD015

Temporary Residency License

Title	Form Number
Application for Temporary Residency License (PDF) Only required if sending a paper application by mail, includes form POD-LIC-006A-E and POD-LIC-006B-E.	POD-LIC-006-E
Memorandum of Understanding for Approved Residency Program (PDF) Required for first year applicants only - attach to online application.	POD-LIC-006A-E
Certificate Of Acceptance For Postgraduate Training Program (PDF) Required every year - attach to online application and renewal.	POD-LIC-006B-E
Memorandum of Understanding (MOU) for Conditional Issuance of a Temporary Residency License (PDF)	POD007

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)	POD009

Podiatric Practices

Title	Form Number
Electronic Prescribing Waiver Form (PDF)	POD014
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
Occupational License Application Claiming to Have No Social Security Number	GC001
Military Service Member, Military Veteran, or Military Spouse Supplemental Application (PDF)	MIL001