YOUR OWN READY-MADE ONLINE SYSTEM SIGN UP TODAY Practice Name * Your Name Create a Username – this will be your own unique location for your Patient Portal * Your URL will be youroptomshop.optomdirect.com Have a coupon code? Access Code Generating Order Summary… Description Subtotal No products in shopping cart. Reorder Reminder – {{ line_item.title }} Remove {{ line_item.title }} Remove {{ wu_format_money(line_item.subtotal) }} / {{ line_item.recurring_description }} {{ wu_format_money(line_item.subtotal) }} Discounts {{ wu_format_money(order.totals.total_discounts) }} Taxes {{ wu_format_money(order.totals.total_taxes) }} Today’s Grand Total {{ wu_format_money(0) }} {{ wu_format_money(order.totals.total) }} Total in {{ $moment.unix(order.dates.date_trial_end).format(`LL`) }} – end of trial period. {{ wu_format_money(order.totals.total) }} Next fee of {{ wu_format_money(order.totals.recurring.total) }} will be billed in {{ $moment.unix(order.dates.date_next_charge).format(`LL`) }}. Discount applied: {{ order.discount_code.name }} – {{ order.discount_code.code }} ({{ order.discount_code.discount_description }}) {{ wu_format_money(-order.totals.total_discounts) }} Remove Email * Password * Strength Meter Confirm Password * Payment Method You will be redirected to a checkout to complete the purchase. You will be redirected to PayPal to complete the purchase. After you finish signing up, we will send you an email with instructions to finalize the payment. Your account will be pending until the payment is finalized and confirmed. I agree to the Terms & Conditions Submit
