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BMP Form and Stethoscope

Forms & Information Required for Licensure and Certification in Vermont

All applicants must complete both the online application and the forms below. Applications will not be complete without the submission of the forms that must be downloaded from this site. We encourage electronic submission of these forms by sending them to AHS.VDHMedicalBoard@vermont.gov

Forms are provided in a fillable PDF format. Digital signatures are acceptable when completing these documents. To access the digital signature portion of the fillable format, you must download and complete the form in Adobe. Free versions of Adobe can be found at Download Adobe Acrobat Reader: Free PDF viewer. Instructions to setup an Adobe digital signature can be found here.

For questions about licensing or applications call (802) 657-4223 or email AHS.VDHMedicalBoard@vermont.gov 

 

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Vermont Prescription Monitoring System (VPMS)

Telehealth Registration and Licensure Information NEW
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Board of Medical Practice WellBeing Champion logo

The Vermont Board of Medical Practice Has Been Recognized as a WellBeing First Champion.

This annual distinction means that our applications for licensure are free from intrusive and stigmatizing language around mental health care and treatment. Applicants can apply with confidence knowing that our applications comply with recognized best practices. 

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You can now pay for licensing verifications, outstanding application fees, and financial penalties with a card online by logging into your eLicense account. 

For more information contact AHS.VDHMedicalBoard@vermont.gov 

License Verifications

Our eLicense website rosters are considered a Primary Source Verification; however, some states may require direct verification. Direct license verification is $50.00 per verification. To request a direct license verification, follow these steps:

  1. Log Into your eLicense account
  2. Select "Request License Verification"
  3. Fill out the information
  4. Click "Send"

 

Please Note: If you would like to pay by check or money order, please send your payment with a written request including your name, license number, and the address of where the verification needs to be sent. If you would like to have your verification expedited, you are required to provide a prepaid FedEx, UPS, or Priority Mail envelope.

Primary Source Verification

License Reprints

To get a License Reprint you need to:

  • Send a written request including your name, license number, and a $20.00 fee (per reprint).
  • The $20.00 fee (per reprint) can be paid by mailing a check or money order. Checks should be made out to ‘Vermont Department of Health’.
  • Mail to: Vermont Board of Medical Practice, 280 State Drive, Waterbury, VT 05671-8320
  • If you would like to pay by card, please contact AHS.VDHMedicalBoard@vermont.gov for more information.