International Cornea Surgeon Inquiry Form

How Can We Serve Your Cornea Needs?

Enter your information so we can learn more about you and understand your needs. After submitting this form, a team member will respond to you within the next business day. If you are not interested in opening a new account for cornea supply, please simply email us with your inquiry to: info@lwvi.org

To inquire about creating a new account for cornea supply, please enter your information below.

* indicates required fields

Cornea Surgeon Name*

Cornea Surgeon Email Address*

Is the person filling out this form the transplant surgeon?

Yes. I am the transplant surgeon

No. I am not the transplant surgeon

Your Name*

Your Email Address*

Phone Number

City*

Country*

Average Monthly Cornea Transplants

Why are you contacting us today?*

Tell us about your practice or institution

How did you learn about us?

How many corneas are needed per month?

I need tissue for

DSAEK

DMEK

PKP

ALK/DALK

CAIRS

Bowman’s Layer

Dua’s Layer

Glaucoma tube shunts (patch grafts)

Select all that apply

Eye Bank Prepared, Preloaded Grafts for DSAEK / DMEK

I use it now and will continue to use through LWVI

I don’t use preloaded tissue services now, and want to try in the future through LWVI

I want tissue prepared for DSAEK / DMEK, but not preloaded

I prepare tissue myself for DSAEK/DMEK and do not need eye bank prepared tissue

From where do you receive your corneas now?

What fee are your corneas now?

All our tissue passes Eye Bank Association of America medical standards and FDA minimum requirements for transplantation. Do you prefer any criteria above the minimum standards?

Is an import permit required to import human tissue to your country?*

Yes

Do you already have a permit?*

Yes

Do you need any documentation from us?*

Yes

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International Cornea Surgeon Inquiry Form

How Can We Serve Your Cornea Needs?