Submitting Your Medical License

Uploading your Medical License

Please upload a clear, complete, and valid copy of your medical license via the google form here. You must have an active medical license to be able to participate in this course.

Medical licenses must be submitted 2 weeks before the start date of the course. Students who do not submit their medical license by this time will be dropped from the course.

Accepted file typed: Document, Image, PDF

Pleas name your file as follows: lastname_firstname_license

Files not named in this manner will be returned and you will not be permitted to move on in the course until you have resubmitted the file correctly.

Medical License

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Email(Required)

Name(Required)

First Last

Phone Number(Required)

Full Mailing Address(Required)

What is your Licensing Title in the state of the license you will submit to us?

In what state do you hold your license that you will be submitting to us?

Please Upload Your Medical License Here. Please name the file as follows: lastname_firstname_license . Example: Tara Delle Chiaie would be dellechiaie_tara_license . The easiest way for you to rename and upload a file is on your computer.

Max. file size: 50 MB.