Temporary License to Full Genetic Counselor License Applicants
For Temporary to Full Applicants
1. Submit a copy of your ABGC Exam Score Report.
2. Complete Genetic Counselor License application CDPH 4486, pages 1-3, signature on page 3 must be in blue ink.
3. Complete Genetic Counselor License Payment form (CDPH 4487, and attach money order or complete VISA/MasterCard information.
4. Provide a 2” X 2” Passport size photo (head and shoulders only) taken within 60 days of filing this application.
California Department of Public Health Genetic Disease Screening Program Program Standards and Quality Assurance Branch 850 Marina Bay Parkway, F-175 Richmond, CA 94804
"If you are having difficulty accessing this document please contact CDPH at (510) 412-6209 or at PSQAGroup@cdph.ca.gov to request this information in an alternate format."