User Registration - Scotlens Members

Registration

Complete the form below to register for this site. Please note all registrations will be audited and approved manually by staff.

Website Signup Registration Form

First Name *

Last Name *

Account Number

Existing account holders

Account Name

Existing account holders

GOC Number

Existing account holders

Username *

Only lower case letters (a-z) and numbers (0-9) are allowed.

Email Address *

Enter Email

Confirm Email Address *

Confirm Email

Password *

Enter Password

Confirm Password *

Confirm Password

Existing account with us?

I do not have an existing account with you.

Practice Name

Practice Address

Full address including postcode

Reception Telephone

Reception Email

Website

Prescriber Name

Prescriber GOC

If you are human, leave this field blank.