Institute of Therapeutic Sciences Application (C-OMPT/Residency/Fellowship):
Name
Email Id
Address
Telephone
PT licence number
Entry level degree
Institution
Highest earned degree
Institution
Employer
Duration of clinical experience
Practice Setting
ABPTS (OCS) certified
Yes
No
ABPTRFE accredited recidency graduate
Yes
No
I hereby affirm that I have completed all application information accurately and truthfully
Submit
