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DEI on DEMAND!
DEI OFFICE
DEI Live: May 23rd and 24th, 2024
DEI Live: June 27th and 28th, 2024
DEI Live: August 29th and 30th, 2024
DEI Live: October 24th and 25th, 2024
Pay NOW, choose my date LATER (within 6 months)
Please Choose Your Retreat Date
We need to gather some information on EACH attendee in order to customize your forms...
Physician's Name
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Practice Name
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Practice Address
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ARBO number
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My 1st Choice Virtual DEI Date (Thurs or Fri only)
My 2nd Choice Virtual DEI Date (Thurs or Fri only)
My 3rd Choice Virtual DEI Date (Thurs or Fri only)
Please upload a headshot for your promotional print items (it can be from your phone, but no group photos please)
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What Dry Eye diagnostic and treatment equipment do you currently own?
Inflammadry Testing
Tear Lab Osmolarity Testing
Anterior Segment Photography
Oculus 5M Keratograph
Lipiscan
Lipiflow
Tear Care
IPL
LLLT
Meiboflo
iLux
Amniotic Membrane (Prokera)
NuLids
Autologous Blood Serum Drops
BlephEx
Other (Please Specify):
I give permission for DEI to set up a few accounts in order to receive my free product shipments
I do NOT have a freezer in my office
Terms
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Please be sure this date will work for you. By signing below, you understand that your payment is non-refundable and non-transferrable. Thank you, in advance, for understanding the restrictions we have in hosting an event with such limited seating.
I, the undersigned, agree to the terms above.
Dry Eye Institute Confidentiality Agreement
*
I, the undersigned, agree to the terms above.
PLEASE tell your friends you're coming!!!
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