Request An Account

To request access to the website, please fill in your details below, and click the Request An Account button. Please note that missing information may result in access not being approved.

IMPORTANT:  For practice information to be displayed on the "Find an Optician" map it is essential that the Principal Optometrist/Owner/Manager of the practice selects the CONTRACTOR button or if this is not his/her registered category he/she should select the PERFORMER button and follows this link to e-mail Hon. Secretary requesting that the practice information is made visible on the map. 

email-address:
username (id):
Full Name:

User Type (Performer/Contractor): Performer       Contractor
NHS List Number:
 
Display Name (Full Name):
Email:
Company Name:
Address:
Town/City:
County:
Postcode:
Telephone:
Mobile:
Website:
Public Email:
Specialities (separate with a semicolon):
 
Verification:
Enter security code without spaces: