• Contractor information

    This information forms your electronic profile. Please make sure that the same person is completing the whole of the form.
  • This is the email address that you'll receive your onboarding confirmation at.
  • This is in case we need to contact the contractor.
  • Optometrist Details

    This is the optometrist that will provide the service.
  • DD slash MM slash YYYY
  • Payment Information

  • Enter your sort code with no dashes.