Optometric Management

Issues per year: 12

Optometric Management is the award-winning publication dedicated to helping optometrists improve their practice through better patient and business management.

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Business / Industry
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QUALIFICATION FORM

Incomplete forms will not be processed. A complimentary subscription to Optometric Management will be sent to those applicants who qualify. The publisher reserves the right to limit the number of subscriptions accepted.

1.	I wish to receive Optometric Management magazine FREE of charge.

Yes!

NOTE: In order to be considered for a subscription to Optometric Management, you MUST select Yes above. If you do not select Yes, you will not receive a complimentary subscription to Optometric Management.

2.	Please check the ONE category that best describes your business/professional activity:

3.	Which of the following medications do you prescribe? (Check all that apply)

Glaucoma medications

Anti-infective medications

Anti-allergy medications

None of the above

4.	Number of years as an OD:

Less than 1 Year

5 - 9 Years

1 - 2 Years

10 - 19 Years

3 - 4 Years

20 or more Years

5.	What is approximate sales volume of your business?

Over $1 Million

$300,001 - $500,000

$750,001 - $1 Million

$200,001 - $300,000

$500,001 - $750,000

Under $200,000

6.	In order to verify your request for this publication, without the availability of a signature, our audit bureau requires that we ask a personal identifying question. This information is used solely for the purpose of auditing your request. In what state/province were you born?

If you selected Outside of U.S. or Canada, please specify:

7.	May we contact you via e-mail?

Yes

8.	May we contact you via e-mail on behalf of ophthalmic industry suppliers on topics pertinent to you?

Yes

9.	May we contact you via fax?

Yes

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