Saguaro Lake
General Forms

Address Change and/or Name Change

If you are a Board Licensee and wish to change your contact information, please complete the Address and/or Name Change Form and email it to Krishna Poe.

Address Change and/or Name Change

 

License Verification Request

The Board's Directory, powered by Thentia Cloud, now serves as primary source verification of the credential issued by the State of Arizona Board of Psychologist Examiners.  This is the ONLY verification of licensure now provided.  Please have the requesting agency view/print the verification directly from the Board's website.

 

Request for Licensee List

Request a list of licensed psychologists or behavior analysts. 

Request for Licensee List

 

Online Request for Public Records

Use this form to request public records, including a licensee list, online from the Arizona Board of Psychologist Examiners. A person may obtain additional public records related to any licensee, including dismissed complaints and nondisciplinary actions and orders, by contacting the Board directly. (See A.R.S. 32-3214)

If you have any questions regarding public records request, please contact Krishna Poe at [email protected]

 

Request for Public Records

Request a list of licensed psychologists or behavior analysts. 

Request for Public Records

 

Claim Form

Use this form to submit a claim against a psychologist who performed court-ordered services (A.R.S. §32-2081(C).

Claim Form

 

Complaint Form

Use this form to request that the Arizona Board of Psychologist Examiners investigate a licensed psychologist or behavior analyst.

Complaint Form

 

Arizona Statement of Citizenship and Alien Status Form

If you are a U.S. citizen and provided this form and evidence of citizenship with your initial application, you do NOT need to submit this or additional evidence with your renewal.  If you are NOT a U.S. citizen and are renewing your license, please complete and submit this form and send a current government issued picture ID as evidence of lawful presence in the U.S. as required by federal and state laws. 

Arizona Statement of Citizenship and Alien Status Form