Notice of Chiropractic Preceptorship

North Carolina Board of Chiropractic Examiners

TO BE COMPLETED BY PRECEPTOR

A Preceptor is a licensed chiropractic physician who has been designated by an approved chiropractic program to oversee a clinical experience for a chiropractic student.

The program is authorized by: NC GS 90-142.1. Supervised training programs authorized.

Preceptor - NC Licensed DC Name(Required)

Chiropractic Student Name(Required)
MM slash DD slash YYYY

Dates of Preceptorship (approx.)

MM slash DD slash YYYY
MM slash DD slash YYYY

Address of Primary Preceptorship Experience(Required)