INSTRUCTIONS: APPLICATION FOR REPLACEMENT/WALL CERTIFICATE ALABAMA MEDICAL LICENSE

To apply for a new or replacement wall certificate documenting your Alabama medical license, file the form discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners & Medical Licensure Commission of Alabama.

Application For Replacement/Wall Certificate Alabama Medical License Step 1: Enter your license number on the first blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 2: Enter your name on the second blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 3: Enter your mailing street address on the third blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 4: Enter your city on the fourth blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 5: Enter your state on the fifth blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 6: Enter your zip code on the sixth blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 7: Check the first statement if your license was lost.

Application For Replacement/Wall Certificate Alabama Medical License Step 8: Check the second statement if your license was destroyed.

Application For Replacement/Wall Certificate Alabama Medical License Step 9: Regardless of whether your license was lost or destroyed, a notarized affidavit documenting how and when your license was lost or destroyed must be attached.

Application For Replacement/Wall Certificate Alabama Medical License Step 10: Check the third statement if you require a replacement wall certificate due to a name change.

Application For Replacement/Wall Certificate Alabama Medical License Step 11: If requesting a replacement wall certificate due to a name change, give the reason for this change on the next blank line. A copy of the legal document verifying the name change must be submitted with your application.

Application For Replacement/Wall Certificate Alabama Medical License Step 12: Enter your signature on the next blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 13: Enter the date on the next blank line.

Application For Replacement/Wall Certificate Alabama Medical License Step 14: Submit the application to the address given at the bottom of the page, along with your affidavit. Additionally, you must enclose payment for the fee for this service, which is $25.