REGULATIONS
Vol. 35 Iss. 23 - July 08, 2019

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.

Contact Information: Elaine J. Yeatts, Senior Policy Analyst, Department of Health Professions, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4688, or email elaine.yeatts@dhp.virginia.gov.

FORMS (18VAC105-20)

Application Instructions for Licensure/TPA Certification (rev. 7/08).

Form A, Application for a License to Practice Optometry or TPA Certification (rev. 7/08).

Diagnostic Pharmaceutical Agents Endorsement Application (rev. 7/08).

Professional Designation Application (rev. 7/08).

Professional Designation Application Letter (rev. 7/08).

Application for Reinstatement (rev. 7/08).

Form B, Licensure Verification (rev. 7/08).

Application for Registration for Volunteer Practice (9/07).

Sponsor Certification for Volunteer Registration (9/07).

Form C, Approved Graduate Optometric Programs (12/06).

Form D, Certificate of Training (rev. 7/08).

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

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)

VA.R. Doc. No. R19-6043; Filed June 11, 2019, 11:19 a.m.