Applications and Forms

Applications are valid for one year.

Pharmacists

Affidavit Regarding Citizenship Pharmacy  (PDF, 24.51 KB)

Application For Certification of DTMP  (PDF, 244.06 KB)  

Nuclear Pharmacist Application   (PDF, 278.71 KB)

Pharmacist Application for Inactive Status  (PDF, 81.81 KB)  

Pharmacist Application  (PDF, 317.12 KB)  

Pharmacist Online Application Supplement Packet  (PDF, 172.15 KB)  

Qualified Alien Status Form GBP  (PDF, 81.55 KB)  

Reciprocity Information and Supplement Packet  (PDF, 245.2 KB)  

Reinstatement - Reactivation Application  (PDF, 427.46 KB)  

 

Pharmacy Interns

Pharmacy Intern Application  (PDF, 313.58 KB)  

Pharmacy Intern Online Application Supplement Packet  (PDF, 256.74 KB)  

Pharmacy Internship Report  (PDF, 106.56 KB)  

Qualified Alien Status Form GBP  (PDF, 81.55 KB)  

 

Pharmacy Technicians

Affidavit Regarding Citizenship Pharmacy  (PDF, 24.51 KB)

Pharmacy Tech Online Application Supplement Packet  (PDF, 174.66 KB)

Pharmacy Technician Additional Employment Form  (PDF, 19.59 KB)  

Pharmacy Technician Change of Employment Notification Form  (PDF, 109.95 KB)  

Qualified Alien Status Form GBP  (PDF, 81.55 KB)  

 

Pharmacy Facilities

Affiliate Annual Disclosure Statement Form  (PDF, 48.3 KB)  

Durable Medical Equipment Suppliers Facility Application  (PDF, 545.1 KB)

Low-THC Pharmacy Dispensary Specialty Permit  (PDF, 180.85 KB)

Non-Resident Pharmacy Facility Application   (PDF, 727.58 KB)

Non-Resident Pharmacy PIC Change Form   (PDF, 365.85 KB)

Notice Form for Authorized Collection  (PDF, 165.15 KB)

Pharmacy Facility Application   (PDF, 465.69 KB)

Pharmacy Facility Pharm Tech Disassociation Form  (PDF, 78.74 KB)  

PIC Change Request Form  (PDF, 107.38 KB)  

 

Pharmacy Education & CE Programs

Application for Pharmacy School License  (PDF, 450.29 KB)

CE Program Application & Approval Form  (PDF, 70.87 KB)

 

Board Services, Requests, or Petitions

Duplicate Pharmacy License - License Verification Order Form  (PDF, 93.9 KB)  

Petition for Pharmacy Variance or Waiver  (PDF, 150.21 KB)

Roster Request Form  (PDF, 77.26 KB)  

Wall Certificate Order Form  (PDF, 100.26 KB)  

 

Guidelines & Information

Fee Schedule  (PDF, 115.99 KB)  

Instructions for GBOP Background Check  (PDF, 77.96 KB)

Reciprocity Information and Supplement Packet  (PDF, 245.2 KB)  

Secure and Verifiable Documents Under O.C.G.A. 50-36-2  (PDF, 102.2 KB)

 

Board Order Compliance Forms

Quarterly Reporting Form - Employer  (PDF, 123.87 KB)  

Quarterly Reporting Form - Personal  (PDF, 106.92 KB)  

Quarterly Reporting Form - Treatment  (PDF, 121.42 KB)