Referral Program VisualDx Subscription Claim Form In this form, you’re expected to fill the doctor details after he subscribe, make sure to submit the email ID that was used during the subscription. Please enable JavaScript in your browser to complete this form.Your name or registered email *Please make sure to enter your name OR email here, the same one you used to register with Points Solutions Referral ProgramDoctor Name *FirstLastDoctor Email *EmailConfirm EmailCountry *The country where the doctor is locatedAdditional DetailsYou can add any additional notesClaim Subscription