Application - Board of Podiatric Medicine - State of California 2025

1. Click ‘Get Form’ to open the Application - Board of Podiatric Medicine in our editor.
2. Begin by entering your name and license number in the designated fields at the top of the form.
3. Fill in your mailing address, city, state, zip code, phone number, fax number, and email address accurately.
4. Indicate your desired role by checking the appropriate box for Exam Commissioner, Expert Reviewer, or Consultant.
5. Answer the questions regarding prior expert witness and peer review experience by selecting 'yes' or 'no'.
6. If applicable, indicate if you have served as an examiner for any listed organizations by checking the relevant boxes.
7. Confirm completion of an approved residency program and check the corresponding type if applicable.
8. List any general acute care hospital facilities where you have surgical staff privileges in the provided space.
9. Provide details on the percentage of your practice that involves surgery and ankle surgery by selecting from the options given.
10. List three DPMs practicing in California as references along with their contact numbers.
11. Attach your curriculum vitae and ensure to sign and date the application before submission.

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