Optometrists Registration Form

Why do we need this information?

In order to set you up with a Healthmail account we need to ensure you are an Optometrist working in a practice. The information you provide will be authenticated by the Association of Optometrist Ireland. We need your existing email account and mobile phone number so that we can send you a username for your new Healthmail account by email and a password by text message.

Personal Details About your Practice
E.g. OP12345
E.g. (01) 123 4567
       
       
 
Current Email Address
 
Please use an email address accessible by the pharmacy.
Confirm Email Address (Current)

 

Terms & Conditions  
I agree that my information can be viewed by the Association of Optometrist Ireland to authenticate me as eligible for a Healthmail account.