Name Change and Replacement/Duplicate License Requests

Pursuant to A.R.S. § 32-4225(C), "Each licensee is responsible for reporting to the Board a name change and changes in business and home address and phone numbers within ten (10) after any change" (emphasis added). Please use the "Name Change Form" link to complete and submit your name change and supporting documentation:

NAME CHANGE FORM - Download PDF

NAME CHANGE FORM - Online

Please use the "Duplicate License Form" link to request a new wall certificate or a wallet license due to a name change, or if you are requesting multiple wall certificates for multiple offices or to replace a lost or misplaced license.

DUPLICATE LICENSE FORM - Download PDF

DUPLICATE LICENSE - Online

Duplicate License Payment-  $25.00

$25.00 MONEY ORDERS / CASHIERS CHECKS ARE ACCEPTED

You can mail everything to:

Arizona Board of Massage Therapy

1740 W Adams St, Unit 3401

Phoenix, AZ 85007