Please fill the form with these details to help us understand the type of treatment applicable for you or for your family or friend :-
1. First Name (Patient Name)
2. Last Name (Patient Name)
3. Phone Number
4. Email address
5. In the Message Box fill below details of patient.
~ Patient Age
~ Current Refraction of patient (exact spectacle numbers including cylindrical errors) if using contact lens specify contact lens numbers.
~ Lifestyle- outdoor, computers etc / profession
~ Any significant medical or eye history
An Eye report / tests done such as Topography (scan and email the same to firstname.lastname@example.org)
And our representative will contact you in the next 4-8 working hours.