PASSWORD REQUEST FORM
This site requires a username and password.
  Please assign me a username & password.
I already have access, I need to change my password.
I already have access, I need to update my personal information.

Please fill out the following form COMPLETELY. Once your request has been granted by a
representative of the company, a username/password will be sent to your email address.
For Bausch & Lomb Employees
Your Name:
Your Country/location:
Your Business Unit:
Your Function:
Your E-mail address:
Your Phone:
For Non-Bausch & Lomb Employees
Your Name:
Your Company:
Your Function:
Your Country/location:
B&L client/contact name:
Your E-mail address:
Your Phone:
Reason for this Request