Thank you for contacting us. If you wish us to keep you up to date about our products and services, please complete the form below. We ask you to give consent to us collecting and using information about your health. If you give us that consent, you are allowing us to help you and others with visual impairment.
You are not obliged to give us any information about yourself or to give us any consent. But, if you do not provide us with information or consent to our using information about your health, we will not be able to assess whether our products or services are suitable for you.
If you are under 16 please ask your parent or guardian to complete and sign the declaration below.
If you are filling this form in on behalf of another adult, then please make sure you have permission to do so and complete and sign the declaration below.