Please Send Information to My Provider

  • If you would like us to send your provider information about Axon Optics and SpectraShield FL-41 samples, please fill out the form below. You are welcome to request status updates by contacting [email protected] anytime.
  • Patient Information

  • For verification purposes only.
  • Eyecare Provider Information

  • If possible, please enter your provider's address so that we can mail samples.
  • I agree that Axon Optics can contact my eye care provider on my behalf and introduce the Axon Optics SpectraShield FL-41 products.