Client Registration

Vision Care Client Registration

By completing our client registration form you will be redirected to our client assessment form to complete your registration. After a review, you will be informed as to your next step which will include accommodation, use of our EMR (electronic medical record ), and payment options.

Registrant First Name *
Registrant Last Name *
Registrant Address *
Street Address
Address Line 2
City
State / Province / Region

Zip / Postal Code
Country
Registrant Pic *
Person to be register Name *
Person to be register Address *
Street Address
Address Line 2
City
State / Province / Region

Zip / Postal Code
Country
Register Person Pic *
Drop your file here or click here to upload.You can upload up to 1 files.Upload limit exceeded. You can upload only 1 files.
Email *
Confirm Email *
Who will Be Paying *
Payment Method
How will you be paying for our services
Source Of Funds
Any Request
About registered person
Home Phone #
Cell Phone #
Password *
confirm Password *
Weak Password
Password not entered
Strength Indicator
Medical Information Required
By registering as a client you will need to enter the registered person's medical information in our EMR (Electronic Medical Records) This will allowed doctors in Barbados to understand their medical history and keep an updated record. Access to this restricted area will be granted after your meeting and payment have been received.
You must accept our Terms and Conditions to proceed.Click here to view.
Honeypot *

Client Registration

Vision Care Client Registration

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Client Registration

Vision Care Client Registration

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