Pain Management Clinic License Forms

For questions about your Pain Management Clinic license or applying for Pain Management Clinic licensure, contact:

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

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

Request to Add, Delete, Edit or Revise Pain Clinic Information