Virginia Law

Administrative Code

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Virginia Administrative Code
Title 18. Professional And Occupational Licensing
Agency 112. Board of Physical Therapy
Chapter 20. Regulations Governing the Practice of Physical Therapy
6/6/2023

FORMS (18VAC112-20).

Application for Licensure by Examination to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant - form available online at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Application for Licensure by Examination to Practice Physical Therapy (rev. 3/2023)

Application for Licensure by Endorsement to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant - form available online at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Application for Licensure by Endorsement to Practice Physical Therapy (rev. 3/2023)

Application for Reinstatement to Practice Physical Therapy (rev. 3/2023)

Application for Reinstatement after Disciplinary Action (rev. 3/2023)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (rev. 4/2021)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 4/2021)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (rev. 7/2020)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 7/2020)

Instructions: Reinstatement of Licensure to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 4/2021)

Trainee Application - Statement of Authorization (rev. 7/2020)

Trainee Application - Statement of Authorization (Graduates of a Non-Approved PT or PTA Program Who Need to Complete a Full Time 1,000 Hours of Traineeship) (rev. 7/2020)

Trainee Application - Statement of Authorization (320-hour Traineeship) (rev. 7/2020)

320 Hour Traineeship Completion Form (rev. 7/2020)

Educational Authorization Form (rev. 7/2020)

Continued Competency Activity and Assessment Form (rev. 1/2015)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)

Application for Direct Access Certification (rev. 3/2023)

Instructions - Direct Access Certification by Experience (rev. 11/2020)

Instructions - Direct Access Certification by Transitional Doctorate (rev. 11/2020)

Direct Access Patient Attestation and Medical Release Form (rev. 7/2021)

Name/Address Change Form (rev. 7/2020)

Request for Verification of a Virginia Physical Therapy License (rev. 7/2020)

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.