Michigan psychiatric certification form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your legal name in the 'Legal Name' section. Ensure you include your last name, first name, and middle initial.
3. Indicate whether this is a first-time application or an annual renewal by checking the appropriate box.
4. Provide your contact information, including your address, county (if applicable), city, state, zip code, and both primary and secondary phone numbers.
5. Complete the email address field as it is required for communication regarding your application.
6. Answer the felony conviction question honestly and attach any necessary explanations if applicable.
7. Select the regions where you are willing to accept assignments by checking the relevant boxes.
8. Fill out the certification information section with your credentials and test details accurately.
9. List any professional development activities you've completed along with supporting documentation as required.
10. Finally, sign and date the application to attest that all provided information is accurate before submitting it as instructed.

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