Clinic Application

Clinic Application Form

Use this form if you are interested in offering iridodiagnostic assessment services in your clinic.
  • Please let us know more about your clinic or healing art profession.
  • Please upload sample image of the right eye for evaluation. If images are acceptable for assessment, you will receive completed sample assessment report. If images are not acceptable, we will contact you with an explanation. If you do not have eye samples, please explain your requirements below.
  • Please upload sample image of the left eye for evaluation. If image is acceptable for assessment, you will receive completed sample assessment report. If images are not acceptable, we will contact you with an explanation. If you do not have eye samples, please explain your requirements below.
Clinic Registration