Certification Of Physicians and Dentists to Use Acupuncture

Acupuncture Certification Application Forms

Instructions for completing and submitting the forms required for licensure appear below. You may also need to submit additional information (for example, examination scores). Please refer to the license requirements link on the left for complete information regarding all requirements you must meet.

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader External Link Icon installed on your computer. Download times and print quality will depend on your connection speed and printer.

Form 1AC-R - Application for Certification to Use Acupuncture - ( PDF 18 KB)
Complete this form in ink and submit it with the $150 certification fee to the Office of the Professions at the address at the end of the form. Be sure to have your signature notarized by a Notary Public.

Form 2AC - Certification of Acupuncture Education - ( PDF 15 KB)
This form must be completed and submitted by the educational institution. The Office of the Professions will not accept it if submitted by the applicant.

  • Section I: Complete this section of the form before sending it to the school(s) where you completed your professional education. Be sure to sign and date item 9.
  • Section II: The form must be completed and signed by the Registrar of the school and sent directly to the Office of the Professions by that school official in an official school envelope to the address at the end of the form. A Form 2AC must be submitted for each completed program.
Last Updated: April 7, 2014