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ADHS Division of Licensing Services

Long-term Care Facilities License Application Forms

Notice Regarding Application Fees:

A.R.S. § 36-405(C)(1) requires the Department to collect nonrefundable application fees from all health care institutions. All Initial, Renewal, and Change of Ownership applications must include a $50 nonrefundable application fee. The Department will consider any application received without the application fee to be incomplete.  (Note: This does not apply to Child Care Licensing.) Checks shall be made payable to the Arizona Department of Health Services.

NOTE: All applications require an Arizona Statement of Citizenship and Alien Status.

Information provided in PDF files, unless otherwise indicated.