Forms

ADA Accommodations Request

Additional License Certificate Request

Agenda Request Form

Change Notification – Personal Information

Change Notification – Business Information

Complaint Form
Any complaint against Mississippi Licensed Optometrists must be submitted to the Board on a complete and signed complaint form.

Equipment Requirements for Practice Location

License Verification Form

Predetermination

Preceptor Application

Preceptor Reporting Form

Public Information Request

Reinstatement for Licensure

Retired Status Application