Order Dry Eye Products Name* First Last Email* Phone*Preferred Method of Communication* Email Phone My prescription is on record in your office* Yes No Supply Needed* 6 Months 12 Months Delivery Option* Pick-up from Office Delivery Which products do you want to order?* Bruder eye mask I-Relief eye mask I-Drop Pur I-Drop Pur gel I-Drop MGD Hybak Thealoz duo Blephaclean wipes I-Lid 'N Lash wipes Additional Notes