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Form 3A - Verification of Medical Licensure in Another Country

Use this form only if you were licensed and practiced medicine in another country within the 5-year period immediately prior to the date of your application for licensure or a limited permit in New York State.

Please Note: This form must be sent to the Office of the Professions by the licensing jurisdiction. We will not accept this form if it is submitted by the applicant or a third party.

  • Section I: Complete this section of the form before sending it to the licensing authority of each country in which you were licensed to practice medicine within the 5-year period immediately prior to the date of your application for licensure in New York State.
  • Section II: The appropriate official of the licensing authority must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 3A as needed.