Monday, October 23, 2017
 

Vision Statement: The FCLB is the premier international resource for information and consolidated services for ensuring the safe, ethical practice of chiropractic. 
 Mission Statement: Protecting the public by promoting excellence in chiropractic regulation through service to our member boards.

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To apply for FCLB's Passport program, please complete and submit the form below.  If your "home license" is from a member jurisdiction, you will be invoiced $150 for processing once your complete application has been submitted.  For non-member jurisdictions, the fee is $300.
Fees are non-refundable.
For information about the program click here.
Fields marked with an * are required.


Contact Information

File Size: 1000KB Maximum
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Licensure Information
Please include all current and previous chiropractic licenses. 
Your "Home License" will be considered your primary active license for your Chiropractic Passport registration.

  


Diplomates and Specialty Certifications
Please select any diplomates or specialty certifications you hold.
Please note: FCLB does not endorse or approve specific specialty certifications.

DIPLOMATES

CERTIFICATIONS

JURISDICTION CERTIFICATIONS
Mark any that apply.












OTHER DIPLOMATE OR SPECIALTY CERTIFICATION PROGRAMS

If you have listed any certifications or diplomates not included above, you will need to submit a verification. Click here for the instructions and form.


Background Check

FCLB Requires a background check for Passport registration. Click here for the instructions and form.

Please check below to indicate that you understand the background check is essential to this verification process and failing to complete it will prohibit you from obtaining and FCLB Passport.

Government-Issued Passport (for travel)

Malpractice

Passport participants are required to follow the malpractice insurance requirements of their home jurisdiction.
FCLB does not endorse any individual malpractice carrier.

Attestations

Please check the following statements to verify that you will comply.

Once you click "submit" your form will be reviewed for completeness and you will be invoiced the $150 application fee.
Please note that incomplete applications or applications with outstanding balances will not be processed.
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