The Varilux Challenge Review Submission Form

The Varilux Challenge Submission Form
As a valued partner, we want to know how Varilux lenses have supported you in providing your patients with the vision they deserve. Provide a short video or written testimonial describing the experience your patient had after switching to Varilux X Series Lenses and earn a $15 gift card.*
Practice Name*
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
To receive your $15 gift card, submit your video testimonial or written review now.*

I'd like to upload a video of my testimonial.I'll just type my written review.I don't wish to leave a testimonial, or receive a $15 gift card.
Choose the video recording of your testimonial and upload it here.*

Browse Files

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Share your review*
What progressive design was your patient previously wearing?*
Enter the name of your patient's previous lens design.
Rate your patient's experience with their Varilux lenses.*

★★★★★★★★★★★★★★★
I am currently an Essilor Expert.*

YesNo
Do you currently dispense Varilux Lenses? *

YesNo
Should be Empty:

The Varilux Challenge Submission Form