Join Our Partner Network

Physician Partnership Application

Complete the following form to join our partner network. Enrollment is limited within each market. Upon submission, our provider support team will contact you regarding availability and next-steps.

Practice Details

Practice Address (Primary)

Primary Contact

Practice Primary Contact Name

Partnership Details

Have you co-managed with a LASIK practice before?(Required)
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What best describes your scope of practice?
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Services I'm Interested In
Check all of the services you are interested in offering.
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Are you interested in co-managing care?