Alcon | Registration – Ocular Innovations

Practice Specific Personalization

Thank you for purchasing the Engage Ocular “See Brilliantly” Program produced in partnership with Alcon. Please complete this form so we can quickly brand your content. After you complete this form, we will have your platform live within 24 business hours.

Let's Get Started

Please provide practice information on the form below. Some of the practice information is printed on the Cards. Please verify all information before submitting.

Subscription ID*
Use the 8-digit ID# provided in your welcome email.
Practice Name*
Alcon Account Number*
This is a nine digit number
Choose Your Color Scheme
Select Color Scheme*
Choose Your Card Design
Select Card Design*
Upload Your Assets
Practice Logo*
Accepted file types: png, eps, jpg, jpeg, pdf, svg, zip, Max. file size: 100 MB.
Please make sure the file is saved either as a png, jpg, pdf or eps.
Your Headshot*
Accepted file types: png, eps, jpg, jpeg, pdf, svg, zip, Max. file size: 50 MB.
Please make sure the file is saved either as a png, jpg, pdf or eps.
Practice Information
Practice Address*
Street Address Address Line 2 City State ZIP Code
Patient Quick Access Links
Practice Phone*
Practice Email*
Practice URL*
Google Maps Link*

[FIND YOUR LINK] Go to https://www.google.com/maps and enter your practice address. Select the "Share" icon and copy the link.
Does your practice use LenSx Laser*
- Yes
- No
Does your practice use ORA System*
- Yes
- No
How many Cataract consultations do you perform (monthly average)?*
How many Cataract procedures do you perform (monthly average)?*
How many procedures result in an upgrade to a premium lens (monthly average)?*
How many upgrades to a premium lens do you want to do (monthly average)?*
Consent*
I agree to the Terms and Conditions / Privacy Policy
Privacy Policy
Terms and Conditions
Termination Upon Thirty (30) Days Notice:

The services may be terminated by the Practice at any time, upon thirty (30) days written notice. Engage Technologies Group, Inc. (and affiliated brands) may terminate the Services at any time, upon thirty (30) days written notice, provided to the Practice at a publicly accessible email and/or postal address.

Practice Specific Personalization

Let's Get Started

Choose Your Color Scheme

Choose Your Card Design

Upload Your Assets

Practice Information

Patient Quick Access Links

Termination Upon Thirty (30) Days Notice: