Clinician's Name *

First Name

Last Name

How Did You Hear About Us? *

How did you hear about OcuSci?

From a friend

Tradeshow

Facebook

Google Search

Promotional Fax/email

Phone *

(###)

###

####

What do you use to express Meibomian Glands in office?

Choose all that apply

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

Address *

To receive FREE samples please fill in your mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country