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  4. Optometrists

Applications and Forms

  • Optometrist Applications

    Contact PCS for all applications and testing information at:
    Professional Credential Services, Inc. (PCS)
    Tel. 877-887-9727 (toll free) or 615-880-4225
    Website: www.pcshq.com

  • Optometry Renewal Instructions


  • Notice of Office Location pdf format of 			Notice of Office Location


  • DPA and TPA Certification Information pdf format of 			DPA and TPA Certification Information


  • DPA Certification Application pdf format of 			DPA Cert


  • TPA Certification Application pdf format of 			TPA Certification Application


  • Sample Rx Check Form - Interactive PDF Version pdf format of 			Sample Rx Check Form - Interactive PDF Version

    Interactive PDF files can be filled out and printed using Adobe Acrobat Reader. For example, you can click on a field in text or click on a check-box to check it on or off.

  • Sample Rx Check Form rtf format of 			Sample Rx Check Form


  • Verification Request pdf format of 			Verification Request

    If you require a certificate of verification to go to another jurisdiction(s), please submit separate verification request forms with applicable fees for each verification requested.

  • Online Address Change for Optometrists

    The Online Change of Address feature allows you to change your address of record listed in our database. To use this function, you must provide certain information for authorization.

  • Change of Name or Request for Duplicate License for Board of Registration in Optometry

    This PDF form maybe used to request a name change, address change or a duplicate license.

  • Division of Professional Licensure Complaint Form pdf format of 			DPL Complaint Form


  • Health Care Fraud Complaint Application pdf format of 			Health Care Fraud Complaint Application

    Note: The Health Care Fraud Application is for use by insurance companies and fraud agencies.

  • Information and Instructions for Application for MA Controlled Substances Registration for Optometrists

    by Department of Public Health

  • Application for MA Controlled Substances Registration for Optometrists

    by Department of Public Health


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