Request for TTL loupe | ergoptix

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FOR TRIAL AND PURCHASE AND
AFTER-SALES SERVICE: +91 90117 84187

ERGOPTIX Request for TTL Loupe

Name of Doctor

Personal Mobile:

75-85 (1).png

Email

Location / City / PIN Code

Mesurements

L1 & L2

ICD

OCD

IPD

PD Left & PD Right

I hereby confirm that all the details furnished above are authentic and accurate to the best of my belief

Thanks for your interest. You will receive confirmation mail on your registered mail ID.

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