Ray-Ban RX6375

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 Virtual Try On Authorization (click here) and the Ditto Privacy Policy (click here). The Virtual Try On technology tool is offered by Ditto. I understand that I am authorizing For Eyes to disclose my image to Ditto. Ditto can use my information, including my biometric identifiers, to apply prescription eyeglasses and sunglasses virtually to the image and as further described in its Privacy Policy. For Eyes does not save or disclose the image or use it for any other purpose. I understand that For Eyes and Ditto are independent companies and For Eyes has no control over Ditto or the Ditto Privacy Policy.

Please email me a copy of the HIPAA Virtual Try On Authorization and eSIGN Disclosure to: