The items listed below MUST be completed and mailed to the LSBME as part of the initial application process.

• Oath or Affirmation

• Third Party Authorization

• Statement of Legal Name

• FCVS Application

• Background Check – NOTE: If you are a physician on a current LSBME training permit, you do not need to do another background check when applying for full licensure.

Oath or Affirmation
This form must be notarized.  All yes answers must be accompanied by a sworn affidavit.  A sworn affidavit is an explanation (in applicant’s own words) that must be typed and notarized.  Note: If criminal history is found that you did not disclose, you will be required to submit a new Oath or Affirmation, a notarized affidavit as to why you did not disclose the information and a new processing fee equal to the initial licensure fee.  It is important that you answer question 3 accurately and truthfully. Do not take the advice of friends, lawyer, etc.

Third Party Authorization
This form must be notarized.  It authorizes LSBME to obtain information concerning the applicant from third parties.

Statement of Legal Name
Record your name as it appears on each document listed that applies to you.  This form must also be completed by any person whose name is not the same as the name on the birth certificate.  This form must be notarized.

FCVS
You must complete the FCVS application in order to apply for licensure.

Background Check – NOTE: If you are a physician on a current LSBME training permit, you do not need to do another background check when applying for full licensure.
LSBME conducts background checks as part of the application process.  Instructions and forms can be downloaded from our website or materials can be requested by:

• Mail: LSBME, Attn: CBC, 630 Camp Street, New Orleans, LA 70130

• E-Mail: lsbmecbc@lsbme.la.gov

• Phone: (504) 568-6820

Additional Requirements

Fees
Fee must be paid via credit/debit card (Visa, MasterCard or Discover only) if applying online.
Fee must be paid via Personal check/money order if sending in a paper application.
​Fee is non-refundable.

• Licensure- $382.00 (MD/DO).

Birth Certificate/Valid Visa

• U.S. born citizen – submit a notarized copy of birth certificate

• U.S. citizen not U.S. born – submit notarized copy of proof of citizenship (ie certificate of citizenship or consular report of birth abroad).  Naturalized citizen – submit a notarized copy of birth certificate and original Certificate of Naturalization.

• Non U.S. citizen – submit a notarized copy of birth certificate and original current Visa issued by the U.S. Citizenship and Immigration Services.  (Acceptable Visas: H1B, J1, O1, NAFTA-TN or Employment Authorization, or Permanent Resident)

Marriage Certificate/Name Change
Application for licensure in a name other than what appears on the birth certificate requires a notarized copy of official documentation of name change (ie marriage certificate).

Notarization as a “true copy”
Request the notary to certify a copy of your birth certificate and/or marriage certificate as a “true and correct copy of the original”.  If the notary will not certify the document, you can attest that it is a “true and correct copy of the original”.  The notary can then notarize your signature.

Verification of Licenses in Other States
Verification of state licenses are required.  Contact the state board(s) directly to obtain verification of your license.  Please note, there may be a processing fee needed.

Other Information

Verification of Application/Licensure Status
Visit our website www.lsbme.la.gov and log on to your account to verify the progress/status of your application.

Communication with the Board
Mailing Address – LSBME, 630 Camp Street, New Orleans, LA 70130
Questions – Contact our licensing department at licensing@lsbme.la.gov. To find the analyst directly assigned to your application, click on Contact Us.