Ortho-K Clinical Trial

Register Your Interest

Please complete this short form. A member of the Eye & i team will contact you to discuss the study and its preliminary eligibility requirements.

Submitting this form does not commit you to participating and does not guarantee eligibility or enrolment.

Participant's Full Name

Date of Birth

I am completing this form for

Myself My Child

Parent or Guardian’s Name (If Applicable)

Mobile Number

Email Address

Suburb or Post Code

Preferred Contact Method

I understand that this is an expression of interest only and does not guarantee eligibility or enrolment. I agree that Eye & i may contact me about this clinical study using the details provided.

I agree that Eye & i may contact me about this clinical study using the details provided.

03 9133 6270

Ortho-K Clinical Trial

Register Your Interest

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