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Maryland Department of Health
Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists & Music Therapists

  • Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists & Music TherapistsCurrently selected
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Update/Change Requests

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NOTE: All Incomplete Update/Change Requests will be removed from the system, after 6 months of non-activity.

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FORMS: SPEECH-LANGUAGE PATHOLOGY ASSISTANT

  • SA5 Form - Verification of Clinical Hours Submission
  • SA6 Form - Change in Supervision​​ Submission

FORMS: AUDIOLOGY ASSISTANT

  • AUDA6 Form - Change in Supervision/Employment Site Submission​

FORMS: SPEECH-LANGUAGE PATHOLOGIST LIMITED 

  • AS2 Form - Change in Supervision/Employment Site Submission

FORMS​: HEARING AID DISPENSER LIMITED

  • H​A5 Form - Verification of Clinical Hours Submission
  • Sponsor's Affidavit

FORMS: Miscellaneous Change Requests

  • Request to Remove Limited Licensee from License
  • ​Name Change Request Online Application
  • Change of Address Request Online Application
  • ​​Email/Phone Change Request Online Application
  • ​Replacemen​t License Request Online Application​
  • ​Inactive Status Form
  • ​​Public Information Act Submission​ ​
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Maryland Department of Health
201 W. Preston Street, Baltimore, MD 21201
(410)767-6500 or 1-877-463-3464
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