Saguaro Lake
General Forms

Address Change and/or Name Change

According to A.R.S. § 32-2066(B), a licensee must inform the Board of any address change within 30 days. The Board may assess the costs incurred in locating a licensee and may assess a civil penalty of not more than $100 against a licensee who fails to notify the board within 30 days from the date of any change of information required to be reported under this subsection. If you are a Board Licensee and wish to change your contact information, login to the PORTAL and update your information. For NAME CHANGES, you will need to submit a NAME CHANGE REQUEST and include a copy of a government issued ID displaying the new name (a marriage certificate is not sufficient). If you are a new user, you will need to activate your account using your primary email address on file.  A link to access your account will be emailed from [email protected], please check your junk/spam folder. If you have technical issues, please contact Krishna Poe

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 submit a request for copies of public records (see A.R.S. Title 39, Chapter 1). This includes the list of licensed psychologists or behavior analysts and any publicly available address). 

Many public records copies do not require submission of this form as they are available self-service through this website:

Due to the various and complex statutory requirements of A.R.S. Title 39, Chapter 1, Board staff are unable to provide copies of public records immediately and on-demand for walk-in customers to the office. Submitted requests are thoroughly reviewed, and the copies are prepared in accordance with Arizona law. Email transmittal of digital copies of public records is the most efficient, prompt, and cost-effective method to receive them. Staff will communicate with requestors as necessary to facilitate the request; this includes quoting the cost for the copies, and informing of an estimated time frame for their production. Alternatively, members of the public may request to meet with Board staff during a pre-arranged appointment to view the records in the office.

A.R.S. § 32-2082(E) provides that, “Documents associated with an investigation are not open to the public and shall remain confidential. No documents may be released without a court order compelling their production.” Accordingly, certain records associated with a Board investigation are confidential and shall not be provided to a requestor. These include complaint investigative reports, (i.e. the “complaint file”). 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

Online Petition Form - A.R.S. § 41-1033
 

Online Petition Form