Oregon Pain Management Commission (OPMC) Registration

First Name *

Last Name *

Please enter your email address *

Zip Code *

Healthcare setting where you work *

Are you licensed as a health care professional in Oregon?

A. If yes, what regulatory board issues your license?
(Note: If affiliated with more than one board, please select the one most relevant to your practice.)

B. If no, what is your profession?

Employer or Not currently employed: *