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Check Your Subscription Term:

	United States	Canada/Mexico	International
1 Year (12 issues)	$56.00	$88.00	$209.00
2 Years (24 issues)	$97.00	$160.00	$299.00
3 Years (36 issues)	$135.00	$212.00	$369.00

All prices are in U.S. dollars and include shipping and handling.

Business Profile:

Please check if you are:

What is your age?

Years In Practice:

Please check your professional/business status:*

If Other, please specify

If Optometric Student, please check year of school

Which of the following do you buy, specify or influence the purchase of: (check ALL that apply)

22 - Spectacle Lenses/Frames
23 - Instruments & Equipment
24 - Contact Lenses-Solutions
25 - Pharmaceuticals

How many of the following do you prescribe/dispense in an average week? (Please provide #):
Ophthalmic Lenses

Contact Lenses

Rx Prescriptions

What is the approximate annual sales volume at your business?

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Do you currently co-manage surgical patients?

YesNo

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