Clinician's Name *

First Name

Last Name

Attend the Webinar or Receive a Link to the Recording? *

Yes, I will attend the Webinar live

No, I can't attend, but send me a link to the recording

Phone *

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What do you use to express Meibomian Glands in office? *

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Manual expression (Qtip, expressor tools)

Lipiflow

Miboflow

Eyeluxe

IPL

Other

I don't express glands in office

Do you currently stock Dry Eye products in your practice? *

check one

Yes

No

Select the supplements you carry below *

Fish Oil for Dry Eye

Macular Degeneration Vitamins

Hot Compress for Dry Eye

Lid Scrub

N/A

Which Fish Oil Supplements Do You Stock? *

Nordic Naturals

PRN

HydroEye

TheraTears

Other

N/A

Which Dry Eye Compress Do You Stock? *

I don't stock a Compress

Bruder

Eye Eco

OcuSoft

Other

Receive a Sample of the World's Best Dry Eye Compress?

Yes, I'd like a Sample (please fill in your address below)

No thanks, I don't want a sample

Address

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Address 1

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