Office of Licensed Allied Health Professionals - an official New Hampshire Government website
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Forms & Documents

Forms and other documents for licensing by the Office of Licensed Allied Health Professionals.

Electronic Forms

FBI Background Checks

In lue of completing background checks from every State you have ever been license in or resided in for the past 6 years and in all names you have been known by you may complete a FBI background check through this office:

  1. Using the link below you can obtain the application form for the FBI background check.
  2. Have your fingerprints done by a State or Government authorized agent either inked or live scan.
  3. Send the completed application, fee in the amount of $48.25, and the fingerprint card to this office.
  4. Once we have all documents and the fee we submit them to be processed.

These background checks will only be accepted if they are run through this office. If you have them run yourself they will not be accepted.

Form Line Description

Supervision Form Line Descriptions pdf file are designed to assist you in filling out the various forms required for submission by the Office of Licensed Allied Health Professionals. These documents do not replace the requirements set forth in the Administrative Rules which govern your profession.

General Forms

Genetic Counselors

Occupational Therapists and Assistants

Physical Therapists and Assistants

Respiratory Care Practitioners

Speech-Language Pathologists

Lists, Labels, and Verifications for All Professions

Lists

The Office of Licensed Allied Health Professionals provides lists for each profession. The cost of each list that is provided by email is $20.00 per profession and for a paper copy the cost is $25.00 per profession. Assistants are included in both the occupational therapy list and the physical therapy list. Send your written request to Office of licensed Allied Health Professionals, 121 South Fruit Street, Concord NH 03301, be sure to included your e-mail address if you are requesting the list be sent by email. Include with your request a check in the appropriate amount made out to "Treasurer, State of NH".

Labels

If you are requesting labels the cost of the labels is $35.00 per profession and you provide the labels to be printed on. The labels you must provide are Avery 1" X 2 5/8" Laser 5160. Please contact the office before sending in your request to determine how many labels you will need to provide.

Once your request is received at the Office of Licensed Allied Health Professionals it takes approximately 1 week for lists and up to two weeks for labels.

Verification of Licensure for all Professions

To obtain a letter of verification from the Office of Licensed Allied Health Professionals send a written request and a check in the amount of $25.00 made payable to "Treasurer, State of NH" to the Office of Licensed Allied Health Professionals, 121 South Fruit Street, Concord NH 03301.

We only send verifications via e-mail. Make sure to include the name of the State or organization and e-mail address for that State or organization. All requests must be dated and signed by the licensee requesting the verification.
Once your request is received at the Office of Licensed Allied Health Professionals it takes approximately 1 week to process.

Portable Document Format Symbol Portable Document Format (.pdf). Visit nh.gov for a list of free .pdf readers for a variety of operating systems.


Office of Professional Licensure and Certification
121 South Fruit Street |  Concord, NH 03301
Main Telephone: (603) 271-2152