- What PEPS Is and Who Governs It
- Who Is Eligible to Apply
- Attempt Limits and the Six-Attempt Rule
- Fee and Registration Mechanics
- Exam-Day Requirements: ID, Attire and Equipment
- What the Exam Requires of You: Format and Domains
- Documentation Readiness: The Typed Note
- A Domain-Based Readiness Timeline
- After the Exam: Results and What Does Not Renew
- Frequently Asked Questions
- PEPS is Part III of the NBEO licensure sequence, taken in person at NCCTO in Charlotte, North Carolina.
- Eligibility starts with an ACOE-accredited program: graduation-year students need institutional confirmation, and graduates may apply directly.
- Six attempts combine former CSE and PEPS tries; a seventh requires NBEO Board committee approval.
- The fee is USD 1,490 for administrations beginning August 2026.
What PEPS Is and Who Governs It
Patient Encounters and Performance Skills (PEPS) is Part III of the National Board of Examiners in Optometry (NBEO) examination sequence. It is an entry-to-practice licensure examination, not a standalone certification you collect and renew. That distinction matters when you read requirements: there is no continuing-education cycle attached to PEPS itself, and no periodic PEPS certificate renewal. State licensure maintenance is a separate matter handled by your state board.
Unlike the written Parts I and II, PEPS is a live performance assessment. You examine and counsel standardized patients, perform hands-on clinical skills, and document what you did. The exam is administered in person at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, North Carolina. If you are new to the acronym and its scope, our explainers on what PEPS is and what PEPS stands for cover the basics before you dive into the requirements below.
Who Is Eligible to Apply
Eligibility for PEPS is built around the accreditation status of your optometry program. NBEO recognizes several routes, and which one applies to you determines the paperwork you need.
| Candidate Category | What You Need |
|---|---|
| Graduation-year student | Institutional confirmation from your program |
| Graduate of an accredited program | Graduation from an ACOE-accredited program; you may apply directly |
| Candidate outside those categories | A sponsorship pathway, handled through NBEO eligibility policy |
Graduation-Year Students
If you are still enrolled in your final year, you can apply, but your school must confirm your standing. The program must be accredited by the Accreditation Council on Optometric Education (ACOE), accredited with conditions, or holding preliminary approval. Your institution supplies this confirmation; you cannot self-attest. Start the conversation with your dean's office or clinical education office well before the registration window so the confirmation is not the bottleneck.
Graduates of Accredited Programs
Graduates of accredited programs may apply on their own. If time has passed since graduation, plan extra preparation time, because the exam rewards fluent, current clinical routines rather than recall from coursework alone.
Sponsorship Pathways
Candidates who do not fit the categories above may qualify through sponsorship pathways described in NBEO's eligibility policy. The specific documentation depends on your situation, so review the exam policies and eligibility page on the NBEO site rather than relying on secondhand summaries. If your route is unusual, contact NBEO directly early, since sponsorship paperwork tends to take longer than a routine registration.
Attempt Limits and the Six-Attempt Rule
PEPS replaced the older Clinical Skills Examination (CSE) in the Part III slot, and NBEO counts both together. You have six attempts combined across former CSE and PEPS. If you previously sat the CSE, those tries count against the same limit. Attempts beyond six require approval from an NBEO Board committee, which is not automatic.
For context on how many candidates clear the exam on the first try, see our breakdown of the PEPS pass rate data. In brief, NBEO's published first-time result for the July 1, 2024 to June 30, 2025 administration year was 69.0%. A separate NBEO Institutional Yearly Performance Report 2025 shows a 70.09% U.S. first-time Part III CSE/PEPS rate for 1,628 graduates in a different cohort window. These figures use different populations and periods, and neither is a 2026 pass rate, so treat them as rough context rather than a prediction for your sitting.
Fee and Registration Mechanics
The examination fee is USD 1,490 for administrations beginning August 2026. That is the figure to budget around, and you should also account for travel and lodging to Charlotte, since the exam is delivered at a single national testing center. For a fuller look at the money side, including costs that sit outside the exam fee, read our PEPS cost breakdown.
Registration runs through your NBEO account. Practical points to handle in order:
- Confirm eligibility documentation. Graduation-year students should have institutional confirmation ready; graduates and sponsorship candidates should have their records in order.
- Enter your legal name exactly as it appears on your IDs. The registered name must match your identification, and mismatches can block admission on test day.
- Select an administration and pay the fee. Scheduling windows and deadlines change by year, so check our guide to PEPS exam dates and scheduling alongside the NBEO exam page.
- Plan logistics early. Allow roughly seven hours on site for check-in, orientation, the testing session and check-out.
Exam-Day Requirements: ID, Attire and Equipment
PEPS has requirements that have nothing to do with clinical knowledge but can still end your day if ignored. NBEO enforces them strictly.
What You Must Bring
Arrive prepared to be identified and to present as a clinician.
- Two current signed IDs, one of which must be a government-issued photo ID.
- Professional attire appropriate for patient encounters.
- A white lab coat.
- A registered name that matches your IDs exactly.
What You Leave Behind
Testing areas are controlled environments.
- Outside notes are excluded from testing areas.
- Electronics are excluded from testing areas.
- Clinical equipment is supplied by NCCTO, so you do not bring your own instruments.
Because equipment is provided, practice with the kinds of instruments used in standard optometric examination rather than your personal favorite devices. Familiarity with unfamiliar-but-standard equipment is part of readiness.
What the Exam Requires of You: Format and Domains
Qualifying to sit PEPS is one hurdle; qualifying to pass is another. The exam consists of 12 stations: 10 standardized-patient encounters and two hands-on clinical-skills stations. One encounter is unscored data collection, which leaves nine scored encounters plus two skills stations. These are performance assessments, not multiple-choice questions. Encounters are recorded, and they assess focused history-taking, clinical interpretation, management, typed documentation, patient education and communication.
The session runs 4 hours 30 minutes. Each station has a 3-minute observation period followed by a 15-minute station period, with 4-minute breaks and a 24-minute extended break after cycle 8. Passing requires meeting the overall NBEO cut-off, and results are reported pass/fail without a scaled score. For the specifics, see our guide to the PEPS passing score.
| Official Competency Objective | Weight |
|---|---|
| Clinical Assessment and Interpretation | 29% |
| Management and Documentation | 25% |
| Skills | 22% |
| Patient Education | 13% |
| Communication | 11% |
Documentation Readiness: The Typed Note
One requirement catches candidates off guard: documentation is typed, and it is part of the scored performance. The blueprint describes an electronic SOAP note, while the Candidate Guide specifies Assessment and Plan entries. In practice, that means you should prepare for the current electronic documentation workflow rather than assuming a generic paper SOAP template. Practice writing concise, accurate assessments and plans under the 15-minute station clock, because the note competes with the encounter itself for your time.
Key Takeaway
Rehearse the entire loop, not isolated pieces: focused history, targeted testing, interpretation, management, patient education, then the typed Assessment and Plan, all inside a single 15-minute station. Candidates who drill each skill separately often discover the timing problem only on exam day.
Because Management and Documentation carries 25% of the weighting, documentation is not a clerical afterthought. It is one of the largest levers on your result. Our PEPS study guide goes deeper on building a practice routine around this.
A Domain-Based Readiness Timeline
You do not need a generic study schedule, but a simple sequence tied to the weighted domains helps you allocate effort. Here is one way to order preparation across a few weeks before your administration.
Clinical Assessment and Interpretation (29%)
- Drill focused histories across the nine clinical-presentation categories
- Practice turning findings into a clear working assessment
Management and Documentation (25%) plus Skills (22%)
- Rehearse management decisions and the typed Assessment and Plan
- Run hands-on skills stations on standard equipment until smooth
Patient Education (13%) and Communication (11%)
- Practice plain-language explanations and closing the encounter
- Record yourself, since encounters at NCCTO are recorded
Full-length mock circuits
- Time complete 3-minute observation plus 15-minute station cycles
- Confirm IDs, attire, white coat and name match
Weighting is only part of the picture, since communication threads through every encounter regardless of its own percentage. If you are weighing how demanding this is, our piece on how hard the PEPS exam is offers perspective, and our PEPS cheat sheet condenses key facts for last-minute review. For hands-on rehearsal, you can also use the PEPS practice test site to structure self-assessment.
After the Exam: Results and What Does Not Renew
PEPS is reported pass/fail, with no scaled score in the way Parts I and II report. Results can be verified through NBEO's credentialing channels, which is how state boards and employers confirm outcomes. Because PEPS is a licensure examination component, passing it feeds into your state licensure application. The state board, not NBEO, governs ongoing licensure maintenance, and there is no periodic PEPS certificate to renew.
Many candidates ask whether passing changes career outcomes. Licensure opens the door to practice, and what happens next depends on your setting and market. For related reading, see earnings analysis and our discussion of whether the credential is worth the investment. If you want to practice before you commit your fee, the main practice site is a good place to begin.
Frequently Asked Questions
Graduation-year students with institutional confirmation from an ACOE-accredited, accredited-with-conditions or preliminary-approval program can apply, as can graduates of accredited programs. Sponsorship pathways exist for other candidates under NBEO eligibility policy.
You have six attempts, and former CSE attempts count toward the same total. Going beyond six requires approval from an NBEO Board committee, so plan each attempt carefully.
The fee is USD 1,490 for administrations beginning August 2026. Budget separately for travel and lodging to Charlotte, North Carolina, where NCCTO is located.
Bring professional attire, a white lab coat, and two current signed IDs, including a government photo ID, with a registered name that matches. NCCTO supplies the clinical equipment, and outside notes and electronics are excluded from testing areas.
No. PEPS is an entry-to-practice licensure examination, not a renewable certification. State licensure maintenance is handled separately by your state board.