Program Registration
An example of the registration page employees use. The details are generic samples.
Before you register
Review the program guidelines, register to request approval, and schedule your fitting appointment for the next On-Sight visit.
Program Guidelines
What’s covered and what to expect.
- Program eligibility is confirmed after registration and supervisor approval.
- Any employee-paid costs, when applicable, are reviewed during fitting before your order is finalized.
- Delivery and distribution details are provided after your fitting appointment is completed.
- Orders include required protective components based on program requirements.
To Participate
Four steps, in order.
- Get a copy of your new or current, unexpired eyeglass prescription.
- Complete the program registration form to request approval.
- Upon registration, you'll be redirected to your site's booking page to schedule your fitting appointment.
- Bring your prescription to your fitting appointment, or upload it at registration (recommended).
Registration Form
Below is an example of the form employees complete. It isn’t interactive, but it shows what a program collects.
Example of the registration form employees complete. This preview isn’t interactive.
Employee Information
Employee Full Name *
First Name
Middle Initial
Last Name
Date of Birth *
For records and Rx verification purposes only.
Mobile Phone # *
By providing, you agree to receive SMS text communications about the program.
Personal Email *
To be used as the primary email.
Company Email *
Required for supervisor approval.
Work Site *
This is the site where your fitting appointment will be scheduled.
Have you registered or placed an order through the On-Sight program before? *
For the On-Sight program only.
Supervisor's Information
Supervisor's Name *
First Name
Last Name
Supervisor's Company Email *
Incorrect emails will delay approval.
Prescription Status
To book a fitting appointment, you’ll need a current, valid eyeglass prescription.
Prescription Status *
Eyeglass prescriptions must be current, unexpired, and include the exam or expiration date, the optometrist signature, and a license #.
Scheduling
Upon submission, you’ll be redirected to the appointment booking page for your selected work site to schedule a fitting for the next On-Site Visit.
Please schedule a fitting appointment using the same email and mobile phone # provided above.
- Once your registration is approved, you’ll receive an email confirmation.
- If your registration isn’t approved, you’ll receive an email with next steps and your scheduled appointment will be cancelled pending review.