Join MESVision | MESVision

Register to Join

Please register to receive application forms specific to your profession. Fields marked with an asterisk (*) are required.

about you

First Name: *

Last Name: *

Practice Name: *

Street Address: *

State: *

ZIP/postal code: *

Phone number: *(xxx) xxx-xxxx

Email: *

Your Profession: *

	Ophthalmologist
	Optician
	Optometrist

How did you hear about us?

Please mail the application forms to me.

Terms: There is a non-recurring enrollment fee of $250.00 and an additional fee of $250.00 for doctors who dispense frames and lenses. Each doctor in a group practice must pay the enrollment fee of $250.00: however, there is only one dispensing fee of $250.00 for the office. A fee of $250.00 is required for each additional dispensing office.

I agree to these terms.