Obtain License

Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.

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Physician (MD/DO) by Endorsement/Reciprocity, Locum Tenens and Visiting Professor Application Forms

	Form #	Title
	2070	Application Information Form
	546	Information for Completing Medicine and Surgery Application from # 570
	570	Application to Practice Medicine and Surgery
	2164	Medical Education Verification Form (not necessary if utilizing FCVS and does not apply for locum tenens license)
	2165	Certification of Post Graduate Training (not necessary if utilizing FCVS)
	1934	Work History Medicine and Surgery
	2167	Hospital, Facility and Employer Verification Form - (does not apply for locum tenens or visiting professor license)
	2829	Malpractice Suits or Claims Form (if applies)
	571	Authorization and Waiver
	AMA Site	American Medical Association Physician Profile Data
	1935	Request for Physician Profile Data (required for DO only)
	1445	Disciplinary Inquiries Report (not necessary if utilizing FCVS)
	2252	Convictions and Pending Charges (if applies)
	openbook	This is required to take the online Wisconsin Statutes and Rules exam.
	1988	Notices (Department Information)