License Verification Requests

If you are a current or former LA license holder and would like to request a License Verification Letter to be sent to another state licensing board, please complete and submit the License Verification Request Form.

NOTE: A standardized verification letter is sent electronically from the LBVM to all jurisdictions.

License Verification Request Form

License Verification Request

Your Full Name * required

Your Full Name

First Name

Last Name

Your Email Address * required

Your Phone Number * required

Please enter in (999)999-9999 format.

Which LA license or certificate type do you hold? * required

DVM

DVM Faculty

RVT

CAET

What’s your LA license or certificate number? * required

RECIPIENT DETAILS:

Organization Name

Name of Recipient

First Name

Last Name

Preferred Method of Delivery * required

via Email

via Postal Services (within U.S. or Canada)

via Postal Services (International)

Recipient’s Email Address * required

Recipient’s Address

Recipient's Address

City

State/Province

Zip/Postal

Recipient’s Address

Recipient's Address

City

State/Province

Zip/Postal

Country

Attach Form/Documentation (if applicable)

Maximum file size: 516MB

Authorization & Confirmation

I hereby authorize and request the Louisiana Board of Veterinary Medicine provide the information related to my request to the recipient indicated. This may include public record information regarding my license, including documents and/or records regarding disciplinary action against me.

If you are human, leave this field blank.