Please ensure Javascript is enabled for purposes of website accessibility

For Providers and Offices, please enter the patient's information below, the method they prefer to be contacted, the box that was recommended for them by the doctor, and the doctor's name.  Let the patient know that someone from My Dry Eye Box will be in contact with them to set up their first shipment which will be free and get their information. Thank you!

If you are a provider and would like to discuss being a partner with MyDryEyeBox, please e-mail for more information.