Register for Access to Eyemotion Services

Register for Access to EYEiQ Services

Fill out the form below to register for access to EYEiQ services.

Email:	*
Password:	*
Confirm Password:	*

Password Requirements

Minimum of 8 characters
Passwords must contain characters from at least 2 of the following categories:
- A lowercase letter (a-z)
- An uppercase letter (A-Z)
- A number (0-9)
- A special character such as !,@,#,$,%,^,&,*,(,),

The new password field will turn yellow (strong) or green (stronger), and the submit button at the bottom of the page will be enabled, when your password matches the above criteria.

•Note: If you are experiencing issues with password verification or the submit button being enabled, please check the following:

JavaScript is enabled for your browser
You are not using Internet Explorer 8 or below
Your browser is not in Compatibility Mode (Internet Explorer)

First Name:

Last Name:

Phone:

Ext.

Address:

City:

State:

Zip:

Practice Name:

Job Position (Select all that apply):

Doctor

Clinic Manager

Staff

Web / Marketing

Setup may take 1-2 business days. If you need immediate access during business hours, please contact EYEiQ at (402) 817-7981

* Required Field.