Please note: Each clinic must be licensed using this form. An optometrist providing services through the clinic will list the clinic as a practice location. No additional certification is required of the optometrist.
“Mobile optometry clinic” means an optometrist moving optometric instruments or equipment to a location, other than a building with fixed equipment and instruments maintained for practicing optometry under the conditions described in NRS 636.2899 and NAC 636. The term:
Select any one:
intend to own and/or operate a “mobile optometry clinic” as that term is defined in NRS 636 and NAC 636, and agree to limit the services, geographical regions and persons served by the mobile optometry clinic to medically underserved group and others.
, intend to operate a “mobile optometry clinic” as that term is defined in NRS 636 and NAC 636, and agree to limit the activities, geographical regions and persons served by the mobile optometry clinic to medically underserved group and others identified in NRS and NAC Chapters 636.
“Medically underserved group” means a population that:
choose one or more:
The clinic will utilize a vehicle into which patients will enter for eye examinations.
I recognize that I must keep a written log of each date and address where the mobile optometry clinic offers optometric services, and identify a qualifying parameter for each patient served. I agree to provide a copy of the log to the Board office quarterly, via email.
Credit card information:
NOTE: Payment may be made by mail, with checks payable to NV State Board of Optometry, noting the purpose of the payment. The Board prefers that all applications, documents or forms be submitted electronically. No submissions will be processed or deemed submitted until payment is received.