Lic62 2026

1. Click ‘Get Form’ to open the lic62 in the editor.
2. Begin by filling out the Applicant Information section. Enter your first name, last name, date of birth, social security number, home address, phone number, city, state, zip code, license number (if applicable), and license type.
3. Next, move to the Physician section. This part must be completed by your examining physician. Ensure they print their name, address, city, state, zip code, sign and date the form.
4. In the General Health Assessment section, review the criteria for fitness and mental capability. The physician will need to indicate whether you are medically fit or require accommodations.
5. Finally, authorize the release of your examination information by signing as the applicant at the bottom of the form.

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