The Massage License Texas Lookup form is a crucial document for individuals seeking licensure as a Massage Therapist in Texas. This form verifies licenses held in other states and ensures compliance with Texas regulations. By completing this form, applicants authorize the release of their licensing information, which is essential for a smooth application process.
The Massage License Texas Lookup form serves a crucial role in the process of verifying the licensure of massage therapists, particularly those who have obtained their licenses from states outside of Texas. This form is essential for applicants seeking licensure in Texas, as it requires verification from the licensing authority of the applicant's home state. The form consists of two main sections: the first section is to be completed by the applicant, providing personal information such as name, license number, and contact details. The second section is designated for the out-of-state licensing authority to confirm the applicant's status, including whether the individual is registered, certified, or licensed, and whether their license is active, lapsed, or suspended. Additionally, the form requests specific details regarding the qualifications for licensure in the applicant's state, including educational requirements and examination mandates. This comprehensive verification process ensures that all massage therapists practicing in Texas meet the necessary standards for safety and professionalism.
MASSAGE THERAPY LICENSING PROGRAM
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
P.O. Box 149347, Mail Code 1982
Austin, Texas 78714-9347
OUT OF STATE LICENSE VERIFICATION
The application for licensure as a Massage Therapist in the State of Texas requires this form to be completed by all State Boards where I hold or have ever held a license. My signature below is your authorization to release all information in your files, favorable or otherwise, regarding myself. Section I to be completed by applicant. Please type or print
clearly.
Applicant Name ___________________________________________ License Number __________________
Applicant’s Signature _______________________________________ Date ___________________________
Address __________________________________________________________________________________
P O Box or Street No. CityState Zip
Telephone Number (include area code) ______________________________ Date of Birth ________________
Section II. (Completed by out-of-state licensing authority)
State of ___________________________________________.
This certifies that ____________________________________ is:
(Applicant’s Name)
Registered [ ]
Certified [ ]
Licensed [ ] as a ___________________________________________
Current status of this license/license/certification is:
Active [ ]
Lapsed [ ]
Inactive [ ]
Denied ** [ ]
Suspended** [ ]
Revoked** [ ]
Effective date of License/Registration/Certification________________________________________________
**Please attach a copy of the Findings of Fact and Decision and Order. License/Registration/Certification issued based on:
[
]
Education Requirements
Endorsement/Reciprocity
State Examination
Grandfather Requirements
National Examination
Qualifications for licensure in this state are:
a.Total hours of education ________
b.Number of hours required in Swedish Massage ________
c.Number of hours required in Anatomy & physiology ________
d.
Written examination required? Yes [
No
e.
Practical examination required? Yes [
Please attach a copy of the current massage therapy requirements (rules) for your state. (If current rules have been sent to this office within the last 12 months, please disregard this request.)
I certify that the above information is correct and true. I have enclosed a copy of the requirements for this state. Name of Agency __________________________________ Address _________________________________
Signature ___________________________________ Typed Name __________________________
Title _______________________________________ Date ________________________________
(STATE SEAL)
DSHS Publication # F64-10701 Massage Therapy Application Revised 5/09
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