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Click ‘Get Form’ to open the California Participating Application in our editor.
Begin by filling out the Identifying Information section. Enter your last name, first name, middle name, and any other names you are known by. Provide your home mailing address, telephone number, email address, and birth details.
Proceed to the Practice Information section. Input your practice name, department name (if applicable), and primary office address along with contact details.
Complete the Premedical Education and Medical/Professional Education sections by listing your educational background. Include college/university names, degrees received, and graduation dates.
Fill in the Board Certification section if applicable. List any certifications you hold along with their expiration dates.
Review all sections for accuracy. Use our platform's tools to add any necessary attachments or additional sheets as indicated in the instructions.
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