Clinician's Name *

First Name

Last Name

Phone *

(###)

###

####

What do you use to treat dry eye in office? *

Choose all that apply

Manual expression (Qtip, expressor tools)

Lipiflow

Miboflow

Tear Care

IPL

Eyelux

LLT

I don't treat dry eye in office

Other

I would like to demo the MGrx in Office? *

True

False

I am planning to purchase a Dry Eye Treatment System this year. *

True

False