Name

Organization

Street Address

Street Address (cont.)

City

State

Zip

Country

Work Phone

Fax

Email

Yes, I am interested in the following MedDev Eyelid Closure Products Yes, I am interested in the following MedDev Eyelid Closure Products Contour® and ThinProfile® Gold Eyelid Weight Implants Contour® and ThinProfile® Platinum Eyelid Weight Implants Blinkeze® External Lid Weights Tantalum Sizing Set EyeClose® Adhesive Strips

Yes, I am interested in obtaining additional information on: Yes, I am interested in obtaining additional information on: MRI Safety Complimentary Re-sterilization Program Cleaning Instructions for Tantalum Eyelid Sizing Weights Physician Billing Guide Hospital/Ambulatory surgery Center (ASC) Billing Guide Patient Brochures | Lagophthalmos: The Inability to Fully Close the Eyelids (12 pk.) Blinkeze® Physician Ordering Form Blinkeze® Skin Tone Selector Card

Message