Virginia Board of Pharmacy
Applications & Forms
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print DHP's documents.
Forms and Applications for Pharmacists
Guidance Document 110-2: Information for Applicants for a License as a Pharmacist - September 2009
Application for Pharmacist License by Examination
Guidance Document 110-17: Instructions for graduates of foreign schools of pharmacy - revised September 2009
Pharmacy Intern Application for Graduate of Foreign School of Pharmacy
Affidavit of Practical Experience as a Pharmacy Intern
Application for Reinstatement of Registration as a Pharmacy Intern
Instructions and Application to Reinstate or Reactivate a Pharmacist License
Forms for Pharmacies (In-State)
Pharmacy Closing Notification Form
Registration For A Pharmacy To Be A Collection Site For Donated Drugs
Forms for Other Facilities (In-State)
Medical Equipment Supplier Permit Application
Restricted Manufacturer Permit Application (for OTC drugs or transfilling medical oxygen)
Non-Restricted Manufacturer Permit Application
Wholesale Distributor License Application
Limited-Use Wholesale Distributor License Application
Forms for Facilities (Out-of-State)
Non-Resident Pharmacy Registration Application
Non-Resident Wholesale Distributor Registration Application
Forms for Physicians
Application for a License for a Practitioner of the Healing Arts to Sell Controlled Substances
Permitted Physician Application
Forms Relating to Controlled Substances Registration
DEA Forms
Information regarding the Destruction of Controlled Substances
Information regarding the filing of a Theft/Loss Report - DEA Form 106
Click here to link to DEA's website to obtain a copy of Form 106 - Theft/Loss Report
Application Forms regarding Pharmacy Technicians and Pharmacy Technician Training Programs
Instructions and Application for Registration as a Pharmacy Technician
Instructions and Application to Reinstate a Pharmacy Technician Registration
Affidavit by Free Clinic Director for Limited-Use Pharmacy Technician
Application for Approval of a Pharmacy Technician Training Program
Miscellaneous
Application for approval of an Innovative (Pilot) Program
Application for approval of a Robotic Pharmacy System
Application for Approval of ACPE Pharmacy School Course(s) for Continuing Education Credit
Volunteer Practice Forms
Volunteer Practice Sponsor Form
Application for Registration for Volunteer Practice
Monitoring for Board Orders
Important Information About Your Board of Pharmacy Order
Self Report – Pharmacist or Pharmacy Technician
Performance Evaluation Form – Pharmacist or Pharmacy Technician