Virginia Board of Counseling
Applications and Instructions
Please contact the Board at (804) 367-4610 or coun@dhp.virginia.gov for information on the following forms:
Certified Substance Abuse Counseling Assistants Applications
The links below are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print DHP's documents.
Certified Substance Abuse Counselors
Application packet for Certified Substance Abuse Counselors
Licensed Professional Counselor Application
Application package for Licensed Professional Counselors
Licensed Substance Abuse Treatment Practitioners
Application Packet for Licensed Substance Abuse Treatment Practitioners
Certified Rehabilitation Provider Application
General Application Information
Verification of Experience (Form 2)
Verification of Licensure/Certification (Form 3)
Verification of Out-of-State Supervisor (Form 4)
Application for Reinstatement of a Lapsed Certificate
Marriage and Family Therapist Applications
Application Packet for Marriage and Family Therapist
Registration of Supervision Forms
Registration of Supervision Instructions
Registration of Supervision Form (Form A)
License Verification for Out-of-State Supervisor (Form B)
Quarterly Evaluation Form (3B)
Continuing Education Forms
Continuing Education Summary Form - LPC
Continuing Education Summary Form - LMFT
Continuing Education Summary Form - LSATP
Formal Staffing Attendance Form
Compliance Forms & Information
Self Report Form
Licensed Professional Counselor
Performance Evaluation Form
Supervisor Report Form – Behavioral Sciences
Miscellaneous Forms
Drug Log for Prescribers (.xls)
Employer Notified of Board Order
Prescriber Report to Board of Drugs or Prescription Given to Licensee
Recovery Support Group Attendance Log
Approval Forms
Chaperone Approval Request Form
Supervisor Approval Request – Behavioral Sciences