Application for Certificate to practice as a SUBSTITUTE OPTOMETRIST

pursuant to NAC 636
  • , intend to offer my services as a substitute optometrist at one or more fixed optometric practices to relieve existing practicing optometrists.

  • If I substitute in a single practice location or substitute for a single optometrist for more than 28 cumulative days during the current licensure period, I understand that I must declare that site as a secondary practice location and register the same with the Board.

    I recognize that I must keep a written log of each date and location where I offer substitute optometric services, and the name of each optometrist for whom I substitute. I agree to provide a copy of the log to the Board office quarterly, via email.

  • $0.00
  • MM slash DD slash YYYY
  • American Express
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
  • 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 has been received.
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