PATIENT INFORMATION DVD
Last Name
First Name
Address
Zip Code - City - Country
Cell Phone Number
Fax Number
Email Address
I would like to receive copies of the DVD proposed by EVRS and presenting information to the patient on:
How does vision work? / Cataract / Posterior Vitreous Detachment / Retinal Detachment / Macular Syndromes / Macular Hole
I would like to have the DVD translated into the following language:
Czech
English
French
German
Greek
Italian
Polish
Portugese
Spanish
Turkish
I am aware that I can receive the Patient Information DVDs for free only if the industrial ophthalmic companies (which provide me with vitrectomy machines, IOLs ...) that I mention below accept to sponsor the DVD:
Industrial Ophthalmic Company Name
Number of Vitrectomies per year
Number of IOLs per year
By clicking on submit, I accept the terms and conditions mentioned above.
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