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For questions about your Pain Management Clinic license or applying for Pain Management Clinic licensure,
Contact Application Specialist
HB178 - Law establishing the Pain Management Clinic License
Initial Application for Pain Clinic Licensure
General Information and Application Checklist
Initial License 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
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
General Information & Checklist