Eye Care Professional (ECP) Registration

Practice Information:

Ordering ECP's Information:

Office Point Of Contact:

Additional ECPs (Optional) - Name, Email, Mobile:

How Did You Hear About Us/Comments

Are you affiliated with Vision Source, the VA or DoD?

I agree to receive promotional emails, including special offers, product updates, and exclusive discounts from Regener-Eyes. I can unsubscribe at any time.

Opt-In for SMS

By check this box, I consent to receive SMS for account notification, delivery notifications, customer care, marketing and public service announcements from Regener-Eyes, LLC. Reply STOP to opt-out; Reply HELP for support; Message & data rates may apply; Messaging frequency may vary. Visit https://regenereyes.com/policies/privacy-policy to see our privacy policy and https://regenereyes.com/policies/terms-of-service for our terms of Service.

Return to Store

This form is for Recommending Professionals to create an account to purchase/recommend Regener-Eyes.

Please be advised that all Recommending Professionals accounts are subject to a verification process before activation. We appreciate your understanding and cooperation as we ensure the integrity and authenticity of each account for the benefit of our users.