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Board of Medicine Address
  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.

Downloads
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Download Netscape Netscape
Download Adobe Acrobat Reader Adobe Acrobat (PDF)
PowerPoint Viewer (PPT)

Downloadable Application
Kits for
Limited License

(US and Canadian Graduates only)

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

US or CA Limited Documents

	Limited License Application Kit
	Application Instructions
	Application Checklist
	Initial Limited Application
	Limited Supplement
	Medical Education Verification
	State License Verification
	Limited Evaluation Form
	Authorization for Release
	Name Change Form

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.

Downloadable ApplicationKits forLimited License

Downloadable Application
Kits for
Limited License