Board of Medical Examiners 301 South Park PO Box 200513 Helena MT 59620-0513 (406) 841-2364 or 2361-2026

1. Click ‘Get Form’ to open the renewal application in our editor.
2. Begin by entering your License Number at the top of the form. If you are unsure of your number, contact the Board using the provided phone numbers.
3. Check the box for any changes to your name or address and fill in the new details in the corresponding fields.
4. Complete your current address information, including City, State (MT), Zip Code, and Country (US).
5. Indicate whether you have had any legal or disciplinary actions since your last renewal by answering 'Yes' or 'No'. If applicable, attach relevant documents.
6. Sign and date the form at the bottom to confirm all information is accurate.
7. Submit your completed application along with a check or money order for the appropriate fee before October 31 to avoid penalties.

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