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Pain Management Clinic Forms

 

To apply for an initial pain management clinic certification, please download and fill out the form below. At this time there is no charge for a pain management clinic certification.

Pain Management Clinic Registration Form

 

To withdraw a pending application or cancel certification, please download and fill out the form below.  

Pain Management Clinic Withdrawal/Cancellation Form   (Please note that the acceptance of a request to cancel a pain management clinic certificate does not in any way confirm that said clinic meets one of the registration exemptions outlined here: Pain Mgt Clinic Registration .)

 

Renewal forms will be sent out to both the clinic’s registered physician owner as well as the pain management clinic address at least 90 days in advance of the expiration date.

 

At this time, registered pain management clinics are not able to use the online Chage of Address option.  To submit a change of address for a registered clinic location, please use the form below.

Pain Management Clinic - Change of Address Form

 

Please mail or fax completed forms to the following address:

 

Texas Medical Board

P.O. Box 2029 MC 240

Austin, TX 78768

fax) 512-463-9416