Chiropractic Preceptor Change Form
This form is for Washington State licensed chiropractors who hold an active preceptor credential and need to add or remove the name and information of the clinical postgraduate trainee or regular senior student they supervise. For specific Chiropractic information refer to
WAC 246-808
.
If you have any questions concerning this form please contact
Customer Service through email
or at 360-236-2822.
* Indicates required field. NOTE: You must complete a form for each student/trainee.
Information collected via this document may be subject to release in accordance with
RCW 42.56 (Public Records Act)
.
