Please note: due to high demand, samples will take longer to arrive than expected. More samples are on the way, so please continue to enter your requests. Thank you for your patience! Eye Care Professional Sample Request Thank you for your interest in iVIZIA. We are only able to provide samples directly to Eye Care Professionals. Please visit your eye doctor to request a sample. Simply fill out the required fields below and click on the submit button. First Name Last Name Suffix NPI # Primary Specialty NoneOphthalmologyOptometry Practice Name Email Address Telephone Practice Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip If samples should go to the attention of another person than you, send samples to: Approximate number of dry eye patients per week? I agree to the iVIZIA privacy policy terms I would like to receive educational information and product announcements from iVIZIA CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image above? Enter the characters shown in the image. Get new captcha! Submit Request Leave this field blank
