In order to reinstate a license that has lapsed due to nonrenewal, an applicant must arrange for the submission of the following:

 

A completed application form and fee of $315.00 in the form of a bank check or money order payable to, Treasurer, State of Connecticut”;

 

A brief written summary of the applicant's professional activities since completion of perfusionist education, to include work history (positions, dates, duties), any lapses in active practice.  If not currently practicing as a perfusionist, please also provide an explanation of the applicant's plans for employment and a description of how the applicant intends to refresh his or her skills;

 

A letter submitted directly to this office from the appropriate authority verifying the applicant's most recent clinical experience, including dates and evaluation of clinical performance;

 

Verification of all licenses held, current or expired, forwarded directly from the appropriate authority in any U.S. state, territory in which the applicant is or has ever been licensed as a chiropractor.  Most jurisdictions charge a fee for completion of the verification form.   Please contact the jurisdiction for fee information.  Please select this link for the required form.  

 

Typically, applicants who have been out of the active clinical practice for more than five (5) years may be required to complete additional training or take the national examination prior to reinstatement.  Additional information will be provided to applicants upon receipt of an application for reinstatement.

 

All supporting documents should be submitted directly from the source to:

 

Connecticut Department of Public Health

Perfusionist Licensure

410 Capitol Ave., MS# 12 APP

P.O. Box 340308

Hartford, CT 06134

Phone: (860) 509-7603

Fax:  (860) 707-1982

email:  dph.alliedhealth@ct.gov