* Indicates required entry
Patient Care and Experience Requirement
I have a minimum of 120 hours (approximately 3 weeks of full-time work) of documented patient care.
Please keep patient logs or a notarized letter of attestation from the certified practitioner or supervisor under whom you worked readily available. BOC performs random audits, and evidence of patient care must be available. Failure to document patient care hours may result in revocation of certification.
I have included a copy of the certificate of attendance from a mastectomy fitter entry-level course provider.
Have you been named as a defendant in a professional liability suit during the past five years?
Any professional practice judgments or settlements against you in the past five years?
Has your professional certification/license ever been affected negatively by any agency?
Have you ever been convicted of one or more felonies?
Has Medicaid or any other medical plan ever brought charges against you for any reason?
Has your professional liability coverage ever been restricted, limited, denied, or denied renewal?
I attest that the information reported on this application, and in all accompanying documentation, is true and accurate to the best of my knowledge.
BOC’s testing provider, PSI Services, will send you information for taking your examination by mail and email.
Take your multiple-choice exam at a testing center or from your home or office. - Plus, receive your results instantly after completing the exam.
The issuer of the card identified on this form is authorized to pay the amount shown as Payment Amount upon proper presentation. I agree to pay such Payment Amount (together with any other charges due thereon) subject to and in accordance with the Agreement governing the use of such card. Make Check or Money Order payable to BOC. If your check is returned for any reason, you must submit a bank draft, money order, or credit card payment with an additional fee of $35.00 to cover the returned check processing fee. Applicants applying outside of the contiguous United States will be subject to an applicable surcharge for additional travel expenses. BOC does not offer refunds or accept post-dated checks.