Commonwealth of Massachusetts
  Board of Registration in Medicine
  200 Harvard Mill Square, Suite 330
  Wakefield, MA 01880
  (781) 876-8200
  (781) 876-8395 (TTY)
  Hours M-F; 8:45 a.m. to 5:00 p.m.


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Downloadable Application
Kits for
Limited License
Program Changes

Applicants for limited license program changes in Massachusetts may download any or all of the following forms for use in preparing their application.

• Do not send these forms to the Board of Registration in Medicine. All completed forms must be sent to your training program.



• Do not complete and mail these forms until you have been accepted into an accredited training program.



• Each kit has a set of instructions. Please read the instructions carefully before filling out the forms.