An applicant for reinstatement of a Connecticut license that has lapsed due to nonrenewal shall provide the following documentation:
A completed, notarized application with photo and fee in the amount of $565.00 in the form of a bank check or money order payable to, “Treasurer, State of Connecticut”;
A separate bank check or money order in the amount of $4.75 made payable to, “Treasurer, State of Connecticut”. This payment covers the Department’s cost for querying the National Practitioner Data Bank;
Please do not combine the above two (2) payments into one single payment as such payment can not be processed and will delay the Department's processing of your application.
The applicant’s current curriculum vitae (CV) including a synopsis of professional activity since completion of medical school;
Verification of any out-of-state licenses held, current or expired, submitted directly to this office from the source. Please contact the jurisdiction prior to making a request as some jurisdictions charge a fee for completion of the form;
Verification from the appropriate authority confirming the applicant's most recent employment; including dates and overall evaluation of the applicant's ability to practice medicine with reasonable skill and safety. If the applicant is in private practice, a letter from another physician with whom the applicant has referred patients. Such letter shall indicate dates of the referral relationship and an evaluation of the applicant's ability to practice medicine with reasonable skill and safety.
All supporting documents should be mailed directly from the source to:
Connecticut Department of Public Health Homeopathic Physician Licensure 410 Capitol Ave., MS #12 APP P.O. Box 340308 Hartford, CT 06134 Phone: (860) 509-7603 Fax: (860) 707-1931 Email: dph.healingarts@ct.gov