Book a Call Today: "*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged.Role*PhysicianOffice staff memberPatient who needs assistance Please contact our customer service by calling 1-833-204-9917 or by filling out our contact form here. Name* First Last Practice Name*Email* Phone*Practice Address*Practice City*State*ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYPractice Zip Code*Which medication(s) are you interested in?* Prednisolone Phosphate + Moxifloxacin + Bromfenac 5 mL Prednisolone Phosphate + Moxifloxacin + Bromfenac 8 mL Atropine Sulfate 0.01% 3.5 mL Atropine Sulfate 0.025% 3.5 mL Atropine Sulfate 0.05% 3.5 mL Brimonidine + Dorzolamide 2 mL Brimonidine + Dorzolamide 5 mL Moxifloxacin + Bromfenac 5 mL Prednisolone Phosphate + Moxifloxacin 5 mL Prednisolone Phosphate + Moxifloxacin + Ketorolac 8 mL Prednisolone Phosphate + Bromfenac 5 mL Timolol + Bimatoprost 5 mL Timolol + Brimonidine + Dorzolamide 5 mL Timolol + Brimonidine + Dorzolamide + Bimatoprost 5 mL Tropicamide + Phenylephrine 2 mL Tropicamide + Phenylephrine 10 mL Dexamethasone +Moxifloxacin Injectable 1mL Bimatoprost + Dorzolamide + Timolol 5mL Bimatoprost + Brimonidine + Dorzolamide 5mL Moxifloxacin HCI 0.1% 1ml How did you hear about OSRX?*Online Search (e.g., Google, Bing)EmailDirect Mailer (OSRX Marketing Materials)Industry Meeting/EventIndustry List Email or Website (e.g. ASCRS, Ophthalmology Times)Social Media (e.g. LinkedIn, Instagram)Referral From A ColleagueODspecs.comOtherHow does your practice prefer to order medications? (Select all that apply)* Bulk Prescription Promo CodeCAPTCHA Δ
