Order

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Pharmaceuticals Order Form

Thank you for choosing to order your pharmaceutical needs via our online ordering system. In order to use this form you will need an account with OptiMed. If you do not have an account please complete our online application form or phone our office on 0800 657720.

Name*

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Practice Name*

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Practice Address*

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Email Address*

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Store # if applicable

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Please insert desired quantities in space provided. To see a more detailed explanation of these goods please download our pharmaceuticals listing available in the product menu

I require an esky to keep goods cool*

Yes

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Mydriatics and Cycloplegics

Cyclopentolate0.5%

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Cyclopentolate1.0%

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Phenylephrine 2.5%

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Phenylephrine 10%

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Tropicamide 0.5

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Tropicamide 1.0%

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Mydriacyl 0.5%

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Mydriacyl 1.0%

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Local Anaesthetics

Oxybuprocaine0.4%

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Alcaine

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Antibacterials and Miscellaneous

Chloramphenicol

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Medical Swabs (200)

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OptiStrips FL 100

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Optistrips FL-300

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Schirmer Tear Test with Blue Mark

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Lacrimal lavage and Foreign body tools

25g Lacrimal Cannula

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3ml syringe - 20

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rubber tool for removing foreign bodies

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Meibomian Gland Expression Forcep

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Blephex Tips packs of 20x4

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Stephens Lacrimal Dilator - Double Ended

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Dry Eye Solutions

Blephadex Wipes Box of 30

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Blephadex Foam 50ml Bottle

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Xailin Gel 10g Tube

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Bruder Single Eye Hydrating Compress

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Bruder Double Eye Hydrating Compress

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Anything else you would like?

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Captcha*

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Pharmaceuticals Order Form

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