Log in / Sign up

Home
About
- About Vmax Vision
- FAQ
Instruments
PSF Technology
Tele-Refraction
Encepsion™ Lenses
Doctor Testimonials
Events
Media
For Patients
Contact Us
- Request more Info
- Request Demo
store
321.972.1823

Teledemo

Name*

First Name

Last Name

Name of Practice *

Email *

Phone Number*

Area Code

Phone First 3

Phone Last 4

Address*

Address1

Address 2

City

State

Zip

Type of Practice*

Please provide the required field.

Ophthalmology

Optometry

Both

Other

How many practice locations do you have?

Main reason for interest in Vmax Vision's technology (check as many as apply): *

Please provide the required field.

Tele-refraction instrument

Tele refraction video in conference software

Both

Who currently refracts patients?

Please provide the required field.

Myself

MD's

OD's

Technician

Other

What type of refractor?*

Please provide the required field.

Manual

Automated

Approximately how many patients a day?

Preferred date and time for a demo

Time

How did you hear about us?

Please provide the required field.

Comments:

Submit