Register Your Ocutech

Registering your Ocutech product allows us to learn more about the individuals who obtain them and what they are used for. Your feedback can be pivotal to helping us improve and create new products to support the needs of the visually impaired. All of your information is held confidentially and is NOT shared with anyone. We welcome and invite your feedback.

Feel free to contact us at any time.

Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Phone
Date of Birth
Male or Female?
- Male
- Female
Device Being Registered*
Date Received*
Prescribing Doctor*
Doctor's City*
Doctor's State*
What is the diagnosis for your vision difficulty?
What is your primary goal for use of your Ocutech system?
What is/are your secondary goal(s) (if any) for use of the device?
Would you like to join the Ocutech user forum (to communicate with other Ocutech wearers)?
- Yes
- No
Would you like to become an Ocutech Ambassador?
- Yes
- No
View and Download the Ambassador Application Form

Learn More About the Ambassador Program
Would you like to be updated when new Ocutech products become available?
Yes
No
We welcome your comments: