If you are experiencing any issues completing this form, please contact our Registration Team at [email protected]

Declaration form

Title ^* (required)

First name ^* (required)

Last name(s) ^* (required)

What is your date of birth? ^* (required)

What is your GOC number? ^* (required)

Which register are you on? ^* (required)

Optometrist

Dispensing optician

Student optometrist

Student dispensing optician

Body corporate