Physician's Filing Form

Download the form and fill out using black ink and please print. Date and sign form.

Send the following:

1. Completed registration form with original signature
2. Copy of Massachusetts registration certificate
3. Stamped self-addressed envelope (for a certified copy of the registration certificate)
4. Check in the amount of $50.00 (payable to the City of Cambridge)

Mail the above to:
City Clerk's Office
795 Massachusetts Avenue
Cambridge, MA 02139