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LPIM Application

Application for License Practitioner of Indigenopathic Medicine (LPIM)

AAIP Personal Information

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Full Name(Required)
Gender(Required)
Address(Required)
Office Address(Required)

License Information

Education

Dates Attended

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Questions

Identification

Max. file size: 2 GB.
Max. file size: 2 GB.

Payment

License Practitioner of Indigenopathic Medicine(Required)

Statements

Agree to terms and conditions.(Required)
Consent to a background check.(Required)
Provide a current credit card for annual renewal.(Required)
Acknowledge license recertification every 3 years.(Required)
Agree to pay a tribal donation fee of 5% on gross receipts.(Required)

Note: Curriculum vitae is recommended for a more complete background and training information.