Title of Regulation: 18VAC112-20. Regulations Governing the Practice of Physical Therapy.

Agency Contact: Corie Tillman Wolf, Executive Director, Board of Physical Therapy, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4546, or email corie.wolf@dhp.virginia.gov.

FORMS (18VAC112-20)

Application for Licensure by Examination to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant (rev. 1/11)

Application for Licensure by Endorsement to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant (rev. 1/11)

Application for Reinstatement to Practice Physical Therapy as a Physical Therapist or Physical Therapist Assistant (rev. 1/11)

Instructions - Licensure by Endorsement to Practice as a Physical Therapist or Physical Therapist Assistant (Graduate of an American/Approved Program) (rev. 1/11)

Instructions - Licensure by Endorsement to Practice as a Physical Therapist or Physical Therapist Assistant (Graduate of a Non-American/Non-Approved Program) (rev. 1/11)

Instructions - Licensure by Examination to Practice as a Physical Therapist or Physical Therapist Assistant (Graduate of an American/Approved Program) (rev. 2/10)

Instructions - Licensure by Examination to Practice as a Physical Therapist or Physical Therapist Assistant (Graduate of an Non-American/Non-Approved Program) (rev. 2/10)

Instructions - Reinstatement of Licensure to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 2/10)

Traineeship Application, Statement of Authorization (rev. 3/10)

Traineeship Application, Statement of Authorization (1,000-hour traineeship) (rev. 3/10)

Traineeship Application, Statement of Authorization (480-hour traineeship) (rev. 3/10)

Form L, Certificate of Physical Therapy Education (rev. 3/10)

Continued Competency Activity and Assessment Form (rev. 3/11)

480 Traineeship Completion Form (rev. 3/10)

Application for Direct Access Certification (rev. 1/11)

Instructions – Direct Access Certification (rev. 2/10)

Patient Attestation Form (rev. 7/07)

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

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

Application for Reinstatement to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 4/2017)

Application for Reinstatement after Disciplinary Action (rev. 4/2017)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Endorsement to Practice Physical Therapy (Graduate of a Non-approved Program) (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (rev. 3/2018)

Checklist and Instructions for Application for Licensure by Examination to Practice Physical Therapy (Graduate of a Non-Approved Program) (rev. 3/2018)

Instructions - Reinstatement of Licensure to Practice as a Physical Therapist or Physical Therapist Assistant (rev. 7/2017)

Trainee Application Statement of Authorization (graduates awaiting examination results) (rev. 4/2018)

Trainee Application Statement of Authorization (1,000-hour traineeship) (rev. 6/2018)

Trainee Application, Statement of Authorization (320-hour traineeship) (rev. 6/2018)

320 Hour Trainee Completion Form (rev. 6/2018)

Trainee Application Statement of Authorization (160-hour traineeship) (rev. 6/2018)

160 Hour Traineeship Completion Form (rev. 6/2018)

Education Authorization Form (rev. 2/2019)

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

Continuing Education (CE) Credit Form for Volunteer Practice (eff. 2/2018)

Application for Direct Access Certification - form available online only at https://www.dhp.virginia.gov/PhysicalTherapy/physther_forms.htm

Instructions - Direct Access Certification by Experience (rev. 8/2016)

Instructions - Direct Access Certification by Transitional Doctorate (rev. 6/2015)

Direct Access Patient Attestation and Medical Release Form (eff. 5/2018)

Name/Address Change Form (rev. 6/2018)

Request for Verification of Virginia Physical Therapist License (rev. 6/2018)