Physician and Surgeon
Applications
These forms may be completed online, however, they cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form online, you must print the form and mail it to the address listed.
 Application for License to Practice Medicine and Surgery
Criminal Background Check (now required for initial licensure)
Deadlines for Board Review
Certificate of Post-Graduate Medical Education
Verification of Foreign Medical College
Application for Medical License Reinstatement
Application for Medical License Reinstatement after Discipline-if you have questions regarding your reinstatement, email vicki.bumgarner@nebraska.gov
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