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Virginia EMS Portal
Application for EMS Physician Endorsement
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Submit for Preliminary Approval
Do you have a Portal account with OEMS?
Do you have a Portal account with OEMS?
No
Yes
Required
Application Type
Physician Type
EMS Physician
Duty Physician
Specialty Physician
Required
Personal Details
First Name
Required
MI
Last Name
Required
Suffix
Date of Birth
Required
Degree
SSN
Required
Confirm SSN
Required
Virginia Medical License #
Required
Primary Email
Required
Secondary Email
Contact Details
Home
Required
Address Line 2 (if necessary)
City
State
Required
Zip
Required
Mobile#
Required
Phone#
Work
Required
Address 2 (if necessary)
City
Required
State
Required
Zip
Required
Phone#