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If your state is not listed here, online purchasing for individual and family plans may not be available. Please Contact Us for plan purchasing information.
Would you like to set up an account?
By registering an account, you can monitor the status of your vision plan.
Please e-mail me the information to set up an account.
With a variety of vision plans to meet your specific needs, Vision Care Direct offers you an unparalleled freedom of choice. Whether your vision needs include bifocals, trifocals, progressive lenses, safety wear or computer wear, we have the plan that is right for you.
Platinum Complete 100
IMPORTANT: If you are using a checking account please note that we DO NOT accept saving accounts.
I understand that signing up for an individual and/or family plan from Vision Care Direct requires me to use an in-network doctor. There is no out of network availability.
Relationship to Primary...
Use Primary's address
I affirm that all the information and statements provided by me in this Questionnaire to be true, complete and factual.
I understand that any false or incomplete information regarding this form will affect my membership.
Please note, an electronic signature is legally valid and binding in accordance with the United States Electronic Signatures in Global and National Commerce Act (ESIGN Act).
Also, in accordance with the ESIGN Act you are granted the right to choose to submit a paper copy of this form instead.
If you do not want to sign electronically, you may download and fill out the PDF version of this form.
I hereby acknowledge that I have received, read and understand the Plan I have selected and the options that are available.
Yearly credit card or debit card payment
Monthly credit card or debit card payment
Monthly bank draft payment
(not available in )
Please click the link below to download the monthly bank draft application form. Then, either fax the form to the number provided OR scan
and e-mail the form to firstname.lastname@example.org.
Initial Payment will be withdrawn today and will reccur on this day each month going forward.
Draft Authorization/Member Agreement: Unless I have selected Annual Payment by check or credit card, I hereby authorize Vision Care Direct to charge my account
the application membership fee, to be credited to my account with Vision Care Direct. This authorization is to remain in full force and effect until I notify
Vision Care Direct in writing of its termination. (My bank is authorized to make corrections if necessary). I have read and understand the terms of this authorization.
I agree to maintain membership for a period of one year. Less than one year membership will result in being billed by the doctors at their usual and customary rate,
minus membership fees paid. All membership fees are non refundable.
By submiting this application I agree to these terms.
Vision Care Direct allows you to chose the amount of frame allowance that you and your family needs based on the amount that you spend on frames and lenses.
Please hover over underlined plans to see details.
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VCD Customer Service | 2178 South 900 East Ste. 7 | Salt Lake City, UT 84106 | Fax: 801.466.4113 | Toll Free: 877.488.8900
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