VA Benefit Information Form

  • Please fill out the form below. Our VA National Accounts Manager, Lori Glover, will contact you by email or phone. Axon Optics will also mail you product information to take to your appointment or to your VA representative. Axon Optics will also send the nearest VA with a prosthetic department additional product information on your behalf. Feel free to contact [email protected] if you have additional questions.
  • Veteran Information

  • Please enter your date of birth to better ensure that Axon Optics can communicate with your local VA.
  • Axon does not require this to advocate for you. However, many VA offices require this for verification when we call on your behalf. Having this information may help prevent further delay.
  • VA Information

  • Most VA orders are submitted by the prosthetic department in a VA medical facility rather than satellite offices and clinics.
  • Prescriptions for Axon Optics SpectraShield lenses are usually written by general practitioners, neurologists or ophthalmologists, not the optical shop. Axon Optics is a brand name and should be included on the prescription. Orders are generated from prosthetic and sensory aid departments.
  • This discount brings the price to $51.60 from $134. Taking the frame and product information may increase your chances of benefit approval. Should your VA approve and provide you with our product, this personal Cover Rx purchase can be returned for a refund. The 30 day return policy does not apply to this purchase. Simply email [email protected] an image of the DD-214, USPIC (military ID) or your state ID if your status is listed. You will then receive a unique discount code for checkout.
  • I agree that Axon Optics can contact my medical provider and my VA office on my behalf to explain the purchasing process through Axon Optics. I understand that it may take weeks to months to process an order if this is a VA that has not purchased previously through Axon Optics.