Pain Management Clinic License Forms

To Apply, Click Here: https://gateway.medicalboard.georgia.gov/

• Affidavit of Applicant Owner
• Registration of Professional Business
• Hospitals Notification Form
• Personnel Certification Form

To Renew, Click Here: https://gateway.medicalboard.georgia.gov/

• Pain Mgmt Clinic Renewal Pmt Cover Letter
• Renewal Application Packet
• Pain Mgmt Clinic - Citizenship Affidavit
• Personnel Certification Form

To Apply, Click Here: https://gateway.medicalboard.georgia.gov/

Forms

• Form A- Affidavit of Applicant Owner
• Form B- Registration of Professional Business
• Form C- Hospitals Notification Form
• Personnel Certification Form

General Information & Checklist - Practicing Physician

• Application Form - Practicing Physician

General Information and Checklist - Physician Assistant

• Application Form - Physician Assistant

General Information and Checklist - APRN

• Application Form - APRN

Checklist and General Information - Managing Employee