NEW ACCOUNT SIGNUP
This form is for all new professionals, clinics, doctors, and staff.
If you are a patient/parent please go
HERE
instead.
ALL FIELDS ARE REQUIRED
FIRST NAME
LAST NAME
CLINIC or COMPANY NAME
EMAIL (this is also your USERNAME)
CONFIRM EMAIL
PASSWORD (minimum 8 characters, at least one Uppercase, one Lowercase, one Number, & one Special Char: !, @, #, $, or %)
CONFIRM PASSWORD
If you see this, leave this field blank!
Please check the following indicating you have read and agree to the EYE Toolbox policies:
By checking this box I agree to the Terms of Service: Click here to view
By checking this box I agree to the Privacy Policy: Click here to view
