The Ortho-K Network - for Doctors

Welcome to

Submit Your Practice for The Ortho-K.NETwork Database Search

You must be a qualified ortho-k practicioner to be included in the database.
Enter your qualifications below. Your listing will be added upon verification. Be sure to fill out the form exactly as you want your listing to appear.

Do not use all CAPS or all lower case to draw attention to your listing. It will not be accepted.

All items marked with an * are required. [ privacy policy ]

Please submit only one qualified doctor/location per form.

*** Please do not use this form to update your information. ***
Send: instead. Click here to send photo.

Cost: $35 per listing. Payment subscribes you until 12/31/10. Renewing only? Click here.

Free listing for Orthokeratology Academy of America members. When you join the OAA you will be listed on their website as well as here.

*** Bonus ***
OAA members may include additional offices at no charge.

Complete this form for listing on the Ortho-K.NETwork only or to join the Orthokeratology Academy of America. Payment will be expected upon submission of the form via our secure payment system. Your listing will not appear until payment is made.

* This application is for:
Ortho-K.NET listing only ($35.00)
Ortho-K.NET listing and Orthokeratology Academy of America application ($250)

	*	Name/degree
		Practice Name
	*	Street
	*	City
	*	State/Prov.
	*	Zip
	*	Country
	*	Phone 123-456-7890
*	*	Email Address	for display on ortho-k.net
*	*	Web Page:
			Please link your web page to The Ortho-K.NETwork You may copy this graphic for your page or use a text link http://www.ortho-k.net If your webpage contains information about LASIK, you must give 'equal billing' to Ortho-K or it will not be included.
	*	Education: Include all colleges attended, year and degree

*	*	Professional Memberships: Other	USA: AOA State AAO OAA - Orthokeratology Academy of America
	*	Topographer:

*Comments and Qualifications: What lenses are you using for Ortho-K? (Will not appear on your listing)

Are you making a change to your listing? If yes, please send an instead.

*** Press Submit only Once Wait for screen to clear ***