Forms

Please use our Application Wizard for guidance on how to apply for a license as an Acupuncturist.

Initial Application

FAQ's about Licensed Acupuncturist

Application for a License to Practice as an Acupuncturist

Form A - Claims History Sheet

Allied Initial Supplemental Form

Form C - Clearance from Other State Boards

NCCAOM Certification Form

Reinstatement

Reinstatement application for an Acupuncture license

Other

Licensed Acupuncturist - Recommendation for Examination by a Physician

Please use our Application Wizard for guidance on how to apply for a license as an Assistant Behavior Analyst.

Initial Application

Applications for initial licensure as an Assistant Behavior Analyst are accepted exclusively through our online system.

Instructions for Assistant Behavior Analyst applicants

Allied Initial Supplemental Form

Reinstatement

Reinstatement application for an Assistant Behavior Analyst license

Please use our Application Wizard for guidance on how to apply for a license as an Athletic Trainer.

Initial Application

Applications for initial licensure as an Athletic Trainer are accepted exclusively through our online system.

Online Application Instructions

Allied Initial Supplemental Form

FAQ's about Athletic Trainer licensure

Reinstatement

Reinstatement application for an Athletic Trainer License

Please use our Application Wizard for guidance on how to apply for initial licensure as a Behavior Analyst.

Initial Application

Applications for initial licensure as a Behavior Analyst are accepted exclusively through our online system.

Instructions for Behavior Analyst applicants

Allied Initial Supplemental Form

Reinstatement

Reinstatement application for a Behavior Analyst License

Please use our Application Wizard for guidance on how to apply for a license as a Chiropractor.

Initial Application

Applications for initial licensure as a Chiropractor are accepted exclusively through our online system.

Application instructions for Chiropractor applicants

MD/DO/DC/DPM Initial Supplemental Form

Reinstatement

Reinstatement Application for a Chiropractic License

Requirement for SPEC Transcript

Please use our Application Wizard for guidance on how to apply for a license as a Genetic Counselor.

Initial Application

Applications for initial licensure as a Genetic Counselor or Temporary Genetic Counselor are accepted exclusively through our online system.

Instructions for Genetic Counselor applicants

Instructions for Temporary Genetic Counselor applicants

Allied Initial Supplemental Form

Reinstatement

Instructions and Application for Reinstatement of a Genetic Counselor License

Please use our Application Wizard for guidance on how to apply for a training license as an Intern/Resident/Fellows.

Initial Application

Initial applications for training licenses as an intern, resident, or fellow are now online. If you held a Virginia training license previously, or if you do not have a Social Security number or Department of Motor Vehicles number, you will need to request a paper application from the Board of Medicine at intern-medbd@dhp.virginia.gov. DO NOT USE A TRAINING LICENSE APPLICATION FOR A FULL, UNRESTRICTED LICENSE.  Click here to begin the online application process.

Additional Forms: 

Residency Memorandum (Form A)

Certificate of Professional Education (Form B)

Transfer Request Form

Please use our Application Wizard for guidance on how to apply for a Medicine license. 

Initial Application

Applications for an initial Medicine license are accepted exclusively through our online system.

Instructions for Medicine application by Initial Application

Instructions for Medicine application by Endorsement

Instructions for Medicine application by Reciprocity

MD/DO/DC/DPM Initial Supplemental Form

Reinstatement

The Reinstatement application for MD and DO is under revision.

Please use our Application Wizard for guidance on how to apply become a licensed as a certified professional midwife. 

Initial Application

Instructions and Application for License to Practice as a Certified Professional Midwife

Form A - Claims History

Allied Initial Supplemental Form

Form C - Jurisdiction Clearance

Reinstatement

Reinstatement application for a Certified Professional Midwife license

Request for Removal of Notice/Order

Application for a Duplicate Wall Certificate

Name and Address Change Form

MD/DO/DC/DPM Initial Supplemental Form

Endorsement Supplemental Form

Allied Initial Supplemental Form 

Please use our Application Wizard for guidance on how to apply for a license as a Occupational Therapy and Occupational Therapy Assistant.

Initial Application

Applications for initial licensure as a Occupational Therapy and Occupational Therapy Assistant are accepted exclusively through our online system.

Online application Instructions

Allied Initial Supplemental Form

Supervised Services/Board Approved Practice for Licenses Lapsed 2-6 years

Supervised Services/Board Approved Practic for Licenses Lapsed more than 6 years

Reinstatement

Reinstatement application for an OT and an OTA

Please use our Application Wizard for guidance on how to apply for a license to practice Osteopathic Medicine. 

Initial Application

Applications for initial licensure to practice Osteopathic Medicine are accepted exclusively through our online system.

Instructions for an Osteopathic Medicine online application by Initial Application

Instructions for an Osteopathic Medicine online application by Endorsement

Instructions for an Osteopathic Medicine online application by Reciprocity

MD/DO/DC/DPM Initial Supplemental Form

Reinstatement 

The Reinstatement application for an MD and a DO is under review.

Form D - Request for Physician Profile (link to AOA website)

Please use our Application Wizard for guidance on how to apply for a license as a Physician Assistant.

Frequently Asked Questions and other information for Physician Assistants.

Initial Application

Applications for initial licensure as a Physician Assistant are accepted exclusively through our online system.

Instructions and forms by initial application

Instructions for Physician Assistant Application by Reciprocity

Allied Initial Supplemental Form

ARRT Fluoroscopy Exam Application

Physician Assistant Authorization to Use Fluoroscopy

The following document is not required to have board approval, but must be maintained in the licensee’s file and submitted to the Board upon request:

It is strongly advised, though not required, that the following form be used. You may create your own form; however, the following form does meet the regulatory requirements for documentation.

Practice Agreement as a Physician Assistant

Please use our Application Wizard for guidance on how to apply for a licensed to practice Podiatric Medicine

Initial Application

Applications for initial licensure to practice Podiatric Medicine are accepted exclusively through our online system.

Online application instructions

MD/DO/DC/DPM Initial Supplemental Form

Reinstatement

Reinstatement of a Podiatry License - Please contact Pam Smith for licensure package at Pam.Smith@dhp.virginia.gov.

Please use our Application Wizard for guidance on how to apply for a license as a Polysomnographic Technologist. 

Initial Application

Applications for initial licensure to practice as a Polysomnographic Technologist are accepted exclusively through our online system.

Online application instructions and forms for Polysomnographic Technologists

Allied Initial Supplemental Form

Form C- Clearance from Other Jurisdictions

Reinstatement

Reinstatement application for a Polysomnographic Technologist license

Please use our Application Wizard for guidance on how to apply for a Radiologic Technologist license or a Radiologic Technologist-Limited license. 

FAQ and other information about Radiologic Technology

Initial Application

Applications for initial licensure as a Radiologic Technologist or a Radiologic Technologist-Limited are accepted exclusively through our online system.

Online application Instructions and forms for Radiologic Technologist

Online application Instructions and forms for Limited - Radiologic Technologist

Allied Initial Supplemental Form

Reinstatement 

Reinstatement application for a Radiologic Technologist/Limited Radiologic Technologist license

Please use our Application Wizard for guidance on how to apply for a Radiologist Assistant license. 

Initial Application

Applications for initial licensure as a Radiologist Assistant are accepted exclusively through our online system.

Online Application Instructions and Forms for Radiologist Assistant

Allied Initial Supplemental Form

Please use our Application Wizard for guidance on how to apply for a Respiratory Therapy license. 

FAQ and other information about Respiratory Therapy

Initial Application

Applications for initial licensure to practice Respiratory Therapy are accepted exclusively through our online system.

Online Application Instructions for a License to Practice Respiratory Therapy

Allied Initial Supplemental Form

Reinstatement

Reinstatement application for a Respiratory Therapist

Please use our Application Wizard for guidance on how to apply for a Surgical Technologist registration or Licensed Surgical Assistant license. 

Initial Application

Applications for initial licensure as a Surgical Technologist or a Licensed Surgical Assistant are accepted exclusively through our online system.

Online Application Instructions and Forms for Licensed Surgical Assistant

Online Application Instructions and Forms for Surgical Technologist

Allied Initial Supplemental Form

University Limited/Full-time Faculty/Fellowship for Foreign Graduates

Instructions for Completing an Application for a Limited License to Practice Medicine as a Full-time Faculty Member or as a Full-time Fellow

Application for a Limited License to Practice Medicine as a Full-time Faculty Member or as a Full-time Fellow

Regulations Regarding Limited Licenses to Foreign Medical Graduates

Form G Educational Commission For Foreign Medical Graduates (ECFMG)

Volunteer Practice Sponsor Form

Application for Registration for Volunteer Practice

Application for Restricted Volunteer License (Doctor of Medicine, Osteopathic Medicine, Podiatry or Chiropractic)

Application for Restricted Volunteer License (Licensed Acupuncturist, Physician Assistant, Respiratory Therapist, Occupational Therapist, Radiologic Technologist or Radiologic Technologist Limited)

The Inactive to Active application is for licenses that are currently in a Current Inactive status. If you want to return to a Current Active status, contact the Board at 804-367-4600, Option 2 for an application.

If your license has been in an expired status for less than two-years, you are able to renew it using your established login credentials here. If you need assistance with your login credentials, contact our HelpDesk at 804-367-4444.

If your license has been in an expired status for more than two-years, will need to apply using the reinstatement application for your profession.

90-day Temporary License (SB317)

Virginia Code § 54.1-2408.4, enacted by Chapter 464 of the 2022 Acts of Assembly, permits health care practitioners licensed, certified, or registered in another state or the District of Columbia to temporarily practice in the Commonwealth for 90 days provided certain provisions are met. These individuals may only practice temporarily for 90 days after receiving an offer of employment or contract for services from: (1) a hospital licensed by the Virginia Department of Health, (2) a nursing home, (3) an assisted living facility, (4) a dialysis facility, (5) the Virginia Department of Health, or (6) a local health department.

Eligible employers and contract service recipients must fill out this form and submit it to the Board before the practitioner begins temporarily practicing in Virginia.