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Surgeon Registration Form

Register Your Tissue Preferences Below

Register your parameters for each type of procedure. Your online account will be set-up with this information and serve as a reference for your tissue requests. Some cases may require a unique set of specifications which can be included on the individual request. 

  • Contact Information

  • Surgeon Facility No.1

    Space for additional surgical facilities listed below.
  • Tissue Offer Preferences

  • PKPDSAEK / UT DSAEKDMEK
  • PKPDSAEK / UT DSAEKDMEK
  • PKPDSAEK / UT DSAEKDMEK
  • Tissue Processing Preferences:

    Preferences will be added to your profile and referenced when processing is requested. When custom preferences are necessary for a patient, simply indicate specifics on the tissue request form.

  • DSAEK

  • Processing capabilities are ±25 µm of requested target
  • Please choose one or a combination of markings
  • DMEK

  • Enter additional facilities below or scroll down to submit registration

  • Surgeon Facility No.2

  • Surgeon Facility No.3

  • Surgeon Facility No.4

  • Surgeon Facility No.5

  • Billing Address (if different than Delivery)

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