Clinician's Name *

First Name

Last Name

Phone *

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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? *

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Yes

No

Select the supplements you carry below *

Fish Oil for Dry Eye

Macular Degeneration Vitamins

Hot Compress for Dry Eye

Lid Scrub

HOCL Spra

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

Optase

OcuSoft

OcuSci

Other

Address *

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Address 2

City

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