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STEP 1 :  CHOOSE YOUR LOGIN DETAILS


Join for only $10.00 a year for a Premium Listing.

*Choose UserName:

*Your Email (please verify that it is correct):
*Choose Password:
*Re-enter Password:
   
   
   
STEP 2 : ENTER YOUR PRACTICE DETAILS
*First Name: *I have been in practice for : Years
*Last Name:  

*Primary Insurance :

*Gender:  Female      Male Secondary Insurance:
Clinic: My Primary  Insurance makes up: % of my practice
*Address:           Offer Evening Hours                  Offer Saturday Hours
            Accepting New Patients             Handicapped Accessible
*City:

 Areas of Expertise :(check all that apply) 

 
General eye care Sports Vision  
Contact Lenses LASIK/Refractive surgery  
Pediatric care Non-Laser CRT Methods  
Vision Therapy Treatment of eye disease  
Other:  
*State:
*Zip:
Website:
*Phone:  (Ex: 123-456-7890)
Fax:  (Ex: 123-456-7890)


           *Doctor Bio and/or Clinic Info : 
            (Can be modified later through Doctor Login)

Sample Listing (Bio info)  

   

* Have you ever had any malpractice actions within the past five years (pending , settled, arbitrated, mediated or litigated)?

  No Yes
   

* Has your license to practice , in your profession , ever been denied , suspended , revoked , restricted , voluntarily surrendered while under investigation , or have you ever been subject to a consent order , probation or any condition or limitations by any state licensing board?

  No Yes


How did you find EyeDoctorNetwork.com ?

Search Engine    Mailing Letter    Physician Referral

 
* = Required Fields.

PHOTOS:  We allow one small photo to be included with your paid listing.  This can be a head shot, clinic picture or website screenshot.  Once your account is activated, we will email you with instructions on how to include your photo in you listing.

STEP 3 : PROCEED TO DISPLAY OPTIONS ->

Click "Continue" to continue the new setup process.  You will have an opportunity to review your charges.  You will receive a confirmation email with information on activating and managing you EyeDoctorNetwork account.    

 

Do you agree to site terms and conditions?     No          Yes       


Prefer to setup your account with old fashioned pen & paper?
Download the ORDER FORM and mail/fax it back to us.

 

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