Eye See...Eye Learn®

Forms and Reporting

Key reporting forms required for ESEL program participation.

Patient Exam Forms and Tracking Number

To receive a tracking number for your Eye See…Eye Learn® orders, please complete the report form below with all required information. This tracking number will auto-populate and should then be entered on your Essilor order form to ensure your submissions are accurately recorded and monitored.

If the ESEL Tracking number is not on the order, the order will not be processed.
Submit Patient Exam →

Monthly Reporting

This form is used to collect the number of ESEL eye exams for patients who DO NOT require prescription glasses. The report has been created to make it quick and easy. If you prefer to use the former ESEL RX Patient Exam form to log exams, that is fine too.

Submit Monthly Report →