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Forms

Please select a profession or category from the dropdown to view related 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

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

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

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

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

Supplemental Form

Reinstatement

Reinstatement Application for a Chiropractic License

Requirement for SPEC Transcript

MD, DO, DPM & DC - Continued Competency Form and Instructions

Occupational Therapy - Continued Competency Form and Instructions

Radiologic Technology - Continued Competency Form and Instructions

Respiratory Therapist - Continued Competency Form and Instructions

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

Supplemental Form

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 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

Supplemental Form

Reinstatement

Reinstatement application for MD and DO

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

Initial Application

Application for License to Practice as a Licensed Midwife

Form A - Claims History

Supplemental Form

Form C - Jurisdiction Clearance

Reinstatement

Reinstatement application for a Certified Professional Midwife license

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

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

Supplemental Form

Reinstatement 

Reinstatement application - Reinstatement application for an MD and a DO

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.

Online application instructions and forms

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

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

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

Supplemental Form

Form C - Clearance from other Jurisdictions

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

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

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

 

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)

COVID-19 Emergency - Application for Reactivation/Reinstatement

The Board of Medicine has made accommodations to the licensing process during the COVID-19 emergency. For those who held an unencumbered license within the last 4 years, the fees and continuing education requirements will be waived. Here is the link to the required EO51 Temporary License Application.

The following applications are for those licensees in Current Inactive status. If your license is expired, do not complete this form. Instead, for a license that has been expired for less than 2 years please click here to renew your license. If your license has been expired for more than two years please download a reinstatement application.

Reactivate an Inactive License for an Athletic Trainer

Reactivate an Inactive License for an MD, DO, DPM or DC

Reactivate an Inactive License for a Licensed Midwife

Reactivate an Inactive License for a Licensed Acupuncturist

Reactivate an Inactive License for an Occupational Therapist

Reactivate an Inactive License for an Occupational Therapist Assistant

Reactivate an Inactive License for a Physician Assistant

Reactivate an Inactive License for a Respiratory Therapist

Reactivate an Inactive License for a Radiologist Technologist

Reactivate an Inactive License for a Radiologist Technologist-Limited

Reactivate an Inactive License for a Behavior Analyst / Assistant BA

Reactivate an Inactive License for a Polysomnographic Technologist

Virginia Board of Medicine
medbd@dhp.virginia.gov | Contact the Board
William L. Harp, MD, Executive Director
Lori D. Conklin, MD, President