Osteopathic Physician and Surgeon

Apply for a Retired Volunteer Healthcare Practitioner License

Military Resources: If you are a military member or military spouse, please review our Military Resources page before applying.

The following requirements must be met:

  • A current curriculum vitae or resume outlining your professional work history.
  • A copy of Delegation of Services Agreement for each practice location.  The original must be kept at each practice site.
  • If you have never held a Utah license in the same profession, Official verification of license from at least one state in which you have held an unrestricted license for the profession selected on page 2.  If possible, the verification should include verification of education, degrees and exams.  *NOTE: If the state you are requesting licensure from cannot supply supporting documentation of the requirements met, please contact the board directly for additional instructions.