OPE-SC Supervisor Verification Form

Registered Orthopedic Technologist - Surgical Certified (ROT-SC) Supervisor Verification Form Upload

Fill out the form below accurately indicating your current experience to meet exam requirements along with ROT-SC application form. Please feel free to "save" form at the bottom. You will receive a unique link to the email address provided to return as needed.
Please review details regarding ROT-SC exam - CLICK HERE

Need ROT-SC Exam Verification Form? CLICK HERE to download

Domain Task Areas:
– Perioperative Preparation
– Intra-Operative Management
– Post-Operative Patient Care
– Professional & Ethical Patient Care
Date*

MonthDayYear
Candidate Demographics
ROT certification # (if known):
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address:*
Cell Number:*

Area CodePhone Number
FINAL UPLOAD - ROT Surgical Verification Form*

Browse Files
Submit completed ROT-SC form here - please verify all information has been provided Cancelof
Secure Payment Checkout

Registration Processing Fee:*

ROT SURGICAL CERT Exam Registration$100.00

Includes: Access to ROT Surgical Certified exam (subject to verification)

Total $0.00

Registered Orthopedic Technologist - Surgical Certified (ROT-SC) Supervisor Verification Form Upload