Application for Voluntary Surrender of License

A physician may submit an application to voluntarily surrender their California physician's and surgeon's license. A surrendered license may not be renewed, reissued, reinstated, or restored. To regain licensure, the physician must reapply for a physician’s and surgeon’s license. The physician is subject to current licensing requirements, including examination requirements.

In addition to completing an application to voluntarily surrender the license, the wall certificate and the last wallet (pocket) license issued must be returned to the Osteopathic Medical Board of California (Board). If the wall certificate and/or wallet (pocket) license is not in the possession of the physician, a written explanation must be submitted with the application.

Voluntarily surrender of a license may not be available if the physician is currently under investigation by the Board or if the Board has initiated disciplinary action against the physician.

AN ACCEPTED SURRENDER WHILE UNDER INVESTIGATION OR IN EXCHANGE FOR CEASING AN INVESTIGATION OR SIMILAR PROCEEDINGS; WILL BE REPORTED TO THE NATIONAL PRACTITIONER DATA BANK (NPDB) AND FEDERATION OF STATE MEDICAL BOARDS (FSMB).

Application for Voluntary Surrender of License