Written Certification Request - By Credit Card

Importation Information:

• The Division of Medical Quality Assurance cannot guarantee your certification will meet the deadlines for other State Boards. The current turn around time for certifications is approximately 4 to 6 weeks from receipt. Please check your deadline dates before you submit your certification request.
• Release forms from the licenses are not requested for certifications.
• Exemptions: Financial information, medical information, school transcripts, examination questions, answers, papers, grades and grading keys, which are confidential and exempt forms. 119.07(1) will be withheld pursuant to Chapter 456.057, Florida Statutes. Social Security numbers will also be redacted pursuant to 42 U.S.C. 405(c)(2)(C) (vii)(1).

Instructions for submitting online request and paying by credit card:

NOTE: It is not necessary to mail in any special forms, as Florida generates its own certification that is accepted by all states. Please do not mail in any additional forms.

IMPORTANT: Stop! Do Not Complete This Form For License Renewal. Call (850) 488-0595 for further assistance.

• Complete the form, including full name and license number of licensee to be researched.
• Include name and address where certification is to be sent.
• Enter credit card information.  This is submitted through a secure server.
• Click "Submit Request".
• Your license certification will be processed in the order in which it is received.  The normal processing time is three weeks.