Request for Materials

  • Would you like to request patient materials for your office? Please fill out the form below and we will ship them directly to you.
  • Name
  • Clinic/Surgery Center Name
  • Email
  • Phone
  • Where should we ship the materials?
  • Please identify which materials you would like us to send you.
  • Dropless Materials
  • LessDrops Materials
  • Simple Drops Materials
  • IV Free Materials
  • If you would like to provide additional request or comments, please indicate those below.