Board of Examiners in Optometry

Martin O'Malley, Governor     Anthony G. Brown, Lt. Governor       John M. Colmers, Secretary

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Forms

 

 

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Adverse Reaction to Ophthalmic Drugs Reporting Form This is a PDF file, and requires Adobe Acrobat Reader download.
Application for Partial Waiver Checklist This is a PDF file, and requires Adobe Acrobat Reader download.
 Application for Original License Checklist This is a PDF file, and requires Adobe Acrobat Reader download.
 QEI Committee Peer Review - Clinical Record Worksheet This is a PDF file, and requires Adobe Acrobat Reader download.
Application for Original License This is a PDF file, and requires Adobe Acrobat Reader download.
Lost License Form This is a PDF file, and requires Adobe Acrobat Reader download.
Therapeutic Pharmaceutical Agents Self Assessment Checklist This is a PDF file, and requires Adobe Acrobat Reader download.
Therapeutic Pharmaceutical Agents Visit Patient Log This is a PDF file, and requires Adobe Acrobat Reader download.
Application to use Therapeutic Pharmaceutical Agents This is a PDF file, and requires Adobe Acrobat Reader download.
Application for Licensure by Partial Waiver of Examination This is a PDF file, and requires Adobe Acrobat Reader download.
Complaint Form This is a PDF file, and requires Adobe Acrobat Reader download.
Continuing Education Sponsor's  Application  This is a PDF file, and requires Adobe Acrobat Reader download.
Application to Use Diagnostic Pharmaceutical Agents This is a PDF file, and requires Adobe Acrobat Reader download.
Application for Inactive Status Licensure This is a PDF file, and requires Adobe Acrobat Reader download.
Jurisprudence Exam This is a PDF file, and requires Adobe Acrobat Reader download.
Application for Approval of Clinical Observation for Continuing Education This is a PDF file, and requires Adobe Acrobat Reader download.
Active Practice Affidavit This is a PDF file, and requires Adobe Acrobat Reader download.
 Pro Bono Form and Instructions This is a PDF file, and requires Adobe Acrobat Reader download.
 Non COPE Course Upload FormThis is a PDF file, and requires Adobe Acrobat Reader download.

 

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 Updated 07/20/2010