Pain Management Clinic License Forms

For questions about your Pain Management Clinic license or applying for Pain Management Clinic licensure, submit a request here:

GCMB Requests Portal NextRequest - Modern FOIA & Public Records Request Software

HB178 - Law establishing the Pain Management Clinic License

Initial Application for Pain Clinic Licensure
General Information and Application Checklist
Initial Application	Form A - Affidavit of Applicant Owner	Form B - Registration of Professional Business	Form C - Hospitals Notification Form

Renewal Application for Pain Clinic Licensure
General Information and Checklist
Pain Mgmt Clinic Renewal Pmt Cover Letter
Renewal Application Packet	Form B - Pain Mgmt Clinic - Citizenship Affidavit

Change in Pain Clinic Ownership
General Information and Checklist
Change of Owner Application	DELETE OWNER CHECKLIST	DELETE OWNER APPLICATION
Form A- Affidavit of Applicant Owner	Form B- Registration of Professional Business	Form C- Hospitals Notification Form