Forms and Applications
Act 125/Envision School Health Program
Asbestos and Lead Program
- Essential Maintenance Practices Compliance Statement: Residential Rental Properties (pdf)
- Essential Maintenance Practices Compliance Statement: Child Care Facilities
- Contractor Entity Application Form (pdf)
- Asbestos Contractor Individual Application Form (pdf)
- Asbestos Abatement Project Permit Application Form (pdf)
- NESHAP Notification (pdf)
- NESHAP form general instructions (pdf)
- Lead Abatement Contractor Entity Application Form (pdf)
- Lead Abatement Contractor Individual Application Form (pdf)
- Lead Abatement Project Permit Application Form (pdf)
Asbestos and Lead Program home page
Birth, Death, Civil Union, Marriage Certificate Order Forms
The Health Department keeps the most recent five years of records. After five years, records are transferred to Public Records, the State Archive. Please go to the Public Records site to order certificates that are older than five years.
Board of Medical Practice
Board of Medical Practice home page
Fees (Current and Furture)
Physician
- Initial License Application for Physicians
- Initial Application for Limited Temporary Physician License
Podiatrist
Physician Assistant
Anesthesiologist Assistant
Other Medical Board forms
Prescriber Data-Sharing Program
Emergency Medical Services
- Students and recertifying EMS providers
- EMS course and exam coordinators
- Applications for reciprocity
- Service managers/administrators
Food and Lodging Program
Food and Lodging Program home page
Immunization Registry Program
Internships
Please complete this form and return a copy to vdhco@vdh.state.vt.us. This will allow us to determine a placement opportunity that best matches your request and area of study.
HIV/AIDS Medication Assistance Program, Dental Care Assistance Program
- HIV/AIDS Assistance Programs Application and Instructions (pdf)
- Physician Verification of HIV Status form (pdf)
- Release of Information Form (pdf)
Ladies First
Provider forms
- Ladies First/EDS Provider Enrollment Form (pdf )
- Authorization for Electronic Funds Transfer (pdf)
- EDI Registration (pdf)
- Electronic Data Interchange Trading Partner Agreement (pdf)
Mental Health
Department of Mental Health home page
Public Health Laboratory
- Water and Radon Test Order Form (pdf)
- Water Test Order Form Supplement (pdf)
Provides descriptions of test groupings listed on the Order Form above.
- Water Test Order Form Supplement (pdf)
Public Health Laboratory home page
Radiological Health
WIC: Women, Infant and Children Program
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