Required Documentation:

IMPORTANT: Please have all required documentation ready before purchasing. You will be asked to upload these documents as part of the online process.

• Completed .pdf Application (including all signed statements in .pdf)
• One (1) Passport-Size Photo (2" x 2")
• CPR Card (Unexpired & Healthcare Provider Level)
• Verification of Good Standing from out of state Board(s) (If Applicable) (Sent By 3rd Party)
• Two (2) Moral Character References (Sent By 3rd Party)
• Military ID of spouse and Copy of Marriage Certificate (If Applicable)

Instructions:

• Download & Complete Form
• This is a complimentary (free) service. Email the completed form to: mdh.chiropractic@maryland.gov so we may begin processing.