Council Registration - Trinidad & Tobago Opticians Registration Council

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Optometrist

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Dispensing Optician

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Company

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General Information

Title:

Full Name: *

Former Name(s):

I wish to apply as a: *

Do you currently work in TRINIDAD AND TOBAGO?:

Yes, I do.

No, I do not.

Date of Birth:

Contact Information

Email:

Fax:

Phone Number:

Other Information

Practice Name & Address (if different from above):

Name of employer:

Enter the name of your current employer (If applicable)

Which professional body do you belong to? : *

Please indicate below which professional body you belong to: (eg TTOA/ DOA/relevant overseas body etc)

Location

Address: *

Zip/Post Code:

Fitness to practice

Have you ever been convicted of, or cautioned in relation to, a criminal offence or are you currently being investigated in relation to a criminal offence?: *

Yes

If yes, please specify.:

Have you ever been the subject of an adverse finding by, or are you currently being investigated by, a body which regulates a health or social care profession?:

Yes

If yes, please specify.:

Do you have any mental or physical conditions which might impair your ability to practice?: *

Yes

If yes, please specify.:

Continuing Education

Please indicate CET taken last year: *

Courses:

Point gained:

Distance Learning: Points gained::

Supporting Documents

Payment Receipt Upload: *

1600×1200 or larger

Recent Photo: *

1600×1200 or larger

Please upload a recent photograph with your application

Additional Documents:

1600×1200 or larger

Attestation

Checkbox: *

I understand that the TTORC will use the information I have provided to exercise its proper and statutory functions.

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General Information

Contact Information

Other Information

Location

Fitness to practice

Continuing Education

Supporting Documents

Attestation

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