Diabetic Retinopathy and Macular Edema Information
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Physicians

Free services for your recovering patients! We call your patients before, during and at the end of their equipment rental period. We answer our toll-free number 24/7. Register below to receive a kit with free patient brochures.

Practice Name:
Contact Name:
E-mail:
Phone:
Fax:
Number of Locations:
Shipping Address:
Number of FREE Brochures:
Retinal Physician(s):
Additional Information:
   
Additional Location #1
   
Contact Name:
Email Address:
Phone:
Fax:
Shipping Address:
Number of FREE Brochures:
Retinal Physician(s):
Additional Information:
   
Additional Location #2
   
Contact Name:
Email Address:
Phone:
Fax:
Shipping Address:
Number of FREE Brochures:
Retinal Physician(s):
Additional Information:

Thank you! We will mail brochures to you shortly.

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