REGULATIONS
Vol. 37 Iss. 13 - February 15, 2021

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF OPTOMETRY
Chapter 20
Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC105-20. Regulations Governing the Practice of Optometry.

Effective Date: February 15, 2021.

Agency Contact: Elaine J. Yeatts, Agency Regulatory Coordinator, Board of Optometry, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4688, or email elaine.yeatts@dhp.virginia.gov.

Summary of Public Comments and Agency's Response: No public comments were received by the promulgating agency.

FORMS (18VAC105-20)

Application Instructions for Licensure/TPA Certification (rev. 5/2019)

Application Instructions for Licensure/TPA Certification (rev. 6/2020)

Application for a License to Practice as a TPA-Certified Optometrist, online form available at https://www.dhp.virginia.gov/Optometry/optometry_forms.htm.

Professional Designation Instructions and Application (rev. 5/2019)

Application for Reinstatement (rev. 5/2019)

Application for Registration for Volunteer Practice (rev. 5/2019)

Sponsor Certification for Volunteer Registration (rev. 5/2019)

Certificate of Training (rev. 5/2019)

Applicant License Verification Form (rev. 5/2019)

Employment Verification Form (rev. 5/2019)

Continuing Education Form (rev. 5/2019)

Continuing Education Credit Form for Volunteer Practice (rev. 5/2019)

Name/Address Change Form (rev. 5/2019)

Professional Designation Change Form (rev. 5/2019)

Written Evidence for Injections (rev. 5/2019)

Instructions/Checklist for Reactivation of an Inactive License (rev. 6/2020)

Instructions/Checklist for Reinstatement of an Expired License (rev. 6/2020)

Application for Registration for Volunteer Practice (rev. 6/2020)

Sponsor Certification for Volunteer Registration (rev. 6/2020)

Licensure Verification Form (rev. 6/2020)

Employment Verification Form (rev. 6/2020)

Instructions for Completing the Continuing Education (CE) Reporting Form (rev. 6/2020)

Continuing Education Credit Form for Volunteer Practice (rev. 6/2020)

Name/Address Change Form (rev. 6/2020)

Written Evidence for Injections (rev. 6/2020)

Request for Verification of a Virginia License (rev. 6/2020)

VA.R. Doc. No. R21-6655; Filed January 24, 2021