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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.

 

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Vermont Prescription Monitoring System (VPMS)

Physician

You MUST submit these forms in addition to completing the online application. If you are using the FCVS, you do not need to print out the Medical School Verification Form (UA #2) or the Post-Graduate Training Verification Form (UA #3). That information will be verified and included in the FCVS packet.

Initial Application Forms

Training License Forms

Training License Renewal Forms

Reinstatement Forms

Pro Bono - Free or Reduced Clinic

Pro Bono - Medical Reserve Corps

 

Renewals

MD renewals occur November 30th of even years. Any license issued prior to September 1st of an even year will expire on November 30th of that year, will need to be renewed prior to that date, and will be charged the full renewal fee.

Limited Temporary Licenses (LTL) renewal occurs June 30th every year. LTL licenses will need to be renewed prior to June 30th including the renewal fee.

 

Fees for MD applications are as shown below:
MD ApplicationFee
Initial$650.00
Renewal$525.00
Reinstatement$650.00
Training License ApplicationFee
Initial$75.00
Renewal$75.00

 

Physician Assistants

You MUST submit these forms in addition to completing the online application. If you are using the FCVS, you do not need to print out the Medical School Verification Form (UA #2) or the Post-Graduate Training Verification Form (UA #3). That information will be verified and included in the FCVS packet.

Act 123 of 2020 Updates Laws Regarding Physician Assistant Practice Agreements: Pending issuance of rules, the new law makes significant changes to the requirements for physician assistant supervision and the documentation that must be filed with the Board.

Initial Application Forms 

CME Board Rule Requirements

Termination of Participating Physician Form 

Malpractice Reporting Form (Form A) 

 

Renewals

PA renewals occur January 31st of even years. Any license issued prior to November 1st of an odd year will expire on January 31st of that year, will need to be renewed prior to that date, and will be charged the full renewal fee.

 

Fees for MD applications are as shown below:
ApplicationFee
Initial$225.00
Renewal$215.00
Podiatrists

You MUST submit these forms in addition to completing the online application.

Initial Application Forms

Training License Forms 

Training License Renewal Forms

 

Renewals

DPM renewals occur June 30th of odd years. Any license issued prior to April 1st of an odd year will expire on June 30th of that year, will need to be renewed prior to that date, and will be charged the full renewal fee.

Limited Temporary Licenses (LTL) renewal occurs June 30th every year. LTL licenses will need to be renewed prior to June 30th including the renewal fee.

 

Fees for DPM applications are as shown below:
DPM ApplicationFee
Initial$650.00
Renewal$525.00
Reinstatement$650.00
Training License ApplicationFee
Initial$75.00
Renewal$75.00

 

 

 

 

 

Anesthesiologist Assistants

You MUST submit these forms in addition to completing the online application.

Initial Certification Forms

Secondary Site Forms

Renewal Forms

Employment Termination Form

 

Renewals

AA renewals occur January 31st of even years. Any license issued prior to November 1st of an odd year will expire on January 31st of that year, will need to be renewed prior to that date, and will be charged the full renewal fee.

 

Fees for MD applications are as shown below:
ApplicationFee
Initial$120.00
Renewal$120.00
Secondary Site Additional$55.00
Secondary Site Renewal$55.00
Radiologist Assistants

You MUST submit these forms in addition to completing the online application.

Initial Certification Forms

Secondary Site Forms

Renewal Forms

 

Renewals

RA renewals occur January 31st of even years. Any license issued prior to November 1st of an odd year will expire on January 31st of that year, will need to be renewed prior to that date, and will be charged the full renewal fee.

 

Fees for MD applications are as shown below:
ApplicationFee
Initial$120.00
Renewal$120.00
Secondary Site Additional$55.00
Secondary Site Renewal$55.00
Malpractice Information

Licensees are required to promptly report all forms of adverse information such as: discipline by a hospital or other state licensing body, malpractice cases or arrest. If you have been the subject of such action, and you have not yet reported it to the Board, you must do so immediately.

How must it be reported?

  • Use the Malpractice Reporting Form (Form A)
  • Use the required online application to list the information by date in response to question 112 or 113, as appropriate
  • Submit documentation including the complaint and settlement, release, or other final disposition of the matter

What must be reported?

  • Pending malpractice actions in which you are a named defendant
  • Settlements paid on your behalf
  • Arbitration awards paid on your behalf
  • Judgements entered against you
  • Changes to a matter previously reported (eg: a matter previously reported as a pending malpractice case that has resulted in a judgement, or has been resolved in your favor)

What does NOT need to be reported?

  • Matters that have previously been reported. You need only review the information in your history to verify that it is complete
  • Closed cases for which there was no settlement, arbitration award or judgement. You are not asked to list cases that were dismissed or withdrawn with no findings against you and no payments to the complaining party.
  • Cases that resolved in your favor
  • Cases in which you prevailed, or the matter was withdrawn without payment

Please Note: If you previously reported a case when it was pending, you may report it if it was resolved in your favor, but you are not required to do so.

If you have any questions, email AHS.VDHMedicalBoard@vermont.gov or call (802) 657-4223.

Renewal Information

Renewals require a completed online application, all required documentation, and payment.

Expiration Dates

ProfessionDate
PhysiciansNovember 30th of Even Years
PodiatristsJune 30th of Odd Years
Training LicensesJune 30th of Every Year
Physician AssistantsJanuary 31st of Even Years
Anesthesiologist AssistantsJanuary 31st of Even Years
Radiologist AssistantsJanuary 31st of Even Years

Log Into Your Account to Renew Your License or Certification

Please Note: If you currently hold a license or certification in Vermont, you already have an account and do not need to register. If you need your username and password, use the Recover User ID/Password feature. If this does not work email ahs.vdhmedicalboard@vermont.gov.

Step 1: Log into your account.
Step 2: From the Online Services menu in the upper right corner of the screen, choose Create/Continue Renewal to start the application.

  • If you do not see your information pre-populated in the application, you have chosen the incorrect application.
  • Please make sure you have chosen the renewal application.

If you have questions, email AHS.VDHMedicalBoard@vermont.gov or call (802) 657-4223

How to Check the Status of Your Application

To check the status of your application, log into your eLicense account and follow these steps:

1) Choose Application Status from the online services menu in the upper right corner of the screen

  • This will tell you which items are required to complete your application.
  • Your application will not be processed until ALL information is received by the Board.
  • If the status page is blank, please go back to Online Services and follow Step 2 below.

2) Choose Look Up a License from the Online Services menu, enter only your Last Name and choose Search.

  • If your credential status says Active then your license should arrive in the mail shortly.
  • If you are in a renewal period and your status says Active in Renewal, continue to Step 3.

3) If you look up your license and it still says Active in Renewal and you have already checked your status:

  • From the Online Services menu, choose Create/Continue Renewal.
  • Verify your renewal is complete and has been submitted.

 

Please Note: If you need your username and password, use the Recover User ID/Password feature. If this does not work, please email AHS.VDHMedicalBoard@vermont.gov

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An exclamation point with the word New under it.

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

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. To get a Direct License Verification you need to take the following steps:

  • Send a written request including your name, license number, the address of the location the verification needs to be sent to, and a $50.00 fee (per verification)
  • The $50.00 fee (per verification) needs to be paid with check or money order. Checks should be made out the '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.
  • Please Note: If you would like to have your verification expedited, you are required to provide a prepaid FedEx, UPS, or Priority Mail envelope. 

eLicense Online - Lookup a License

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.