Air Optix® for Astigmatism

I have read the Electronic Record and Signature Disclosure (click here). I agree to use electronic records and signatures.

I have also read and agree to the HIPAA PD Authorization (click here) and the 6over6 Vision Privacy Policy (click here). The PD tool is offered by 6over6 Vision. I understand that I am authorizing For Eyes to disclose my information to 6over6. 6over6 can use my information as described on its Privacy Policy. I understand that For Eyes and 6over6 are independent companies and For Eyes has no control over 6over6 or the 6over6 Privacy Policy.

Please email me a copy of the HIPAA PD Authorization and eSIGN Disclosure to: