Olympic Ophthalmics Contact Form

Name*

First NameLast Name
First Name
Last Name
Name*

First NameLast Name
E-mail*
Question *
How did you hear about us
How can we help?
We will not share your information to third parties.
Phone Number (optional unless no email)

Area CodePhone Number
How did you hear about us*

Online SearchYour DoctorFriend/Colleague
Select one. It's regarding... (optional)

Our companyOur productOur appPlacing an orderOther
Select one. I am a... (optional)

Customer/PatientOphthalmologistOptometristOther
Business Name (if you're an ophthamologist or optometrist) (Optional )
Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
To start with a telehealth prescription please fill out questionnaire:

http://www.itear100.com/q

If your Doctor wrote a prescription, it can be uploaded to :

http://www.itear100.com/upload

This is a prescription product regulated strictly by FDA. There is a device purchase (direct from company) and monthly cost after the first month which includes ongoing warranty, telehealth support, and maintenance of the prescription.

If you are a Doctor, you can write a prescription for a patient through secure portal :

http://www.itear100.com/rx
Should be Empty: