Form Doh 662-097 - Optometrist License Application Packet Page 23
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27Optometry Credentialing
PO Box 47877
Olympia, WA 98504-7877
360-236-4700
Optometry Certification for Diagnostic,
Therapeutic and Oral Drugs
Applicant’s Name ______________________________________________________________
Specific requirements for license are on reverse side.
F Diagnosis—This is to certify the applicant has completed a minimum of
sixty hours of didactic and clinical instruction in general and ocular pharmacology
as established in
WAC
246-851-400. Education must be completed after July, 1981
Name of Accredited Institution__________________________________
School Seal
Date Education Completed ____________________________________
Signature __________________________________________________
F Treatment—This is to certify the applicant has completed an additional
minimum of seventy-five hours of didactic and clinical instruction as established
WAC
246-851-400. Education for treatment purposes must be completed after
in
July 23, 1989
Name of Accredited Institution__________________________________
Date Education Completed ____________________________________
School Seal
Signature __________________________________________________
F Oral—This is to certify the applicant has completed an additional minimum
of sixteen hours of didactic and eight hours of supervised clinical instruction
from an institution of higher learning, accredited by those agencies recognized
by the United States Office of Education or the Council on Postsecondary
Accreditation as established in
WAC
246-851-570. Education for oral certification must
be completed after May 1, 2004.
Name of Accredited Institution__________________________________
Date Education Completed ____________________________________
School Seal
Signature __________________________________________________
DOH 662-095 April 2017
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