Alcon Experience Academy

Trainer Requestor Contact Name *

Trainer Requestor Contact Email *

Trainer Requestor Contact Phone Number *

Center Name *

Country *

Street Address *

City *

State / Province *

Postal Code *

Surgery Center Contact Name *

Surgery Center Contact Email *

Surgery Center Contact Phone Number *

Number of Eyes Scheduled *

Alcon requires a minimum of 5 eyes to schedule an Alcon CAS

CAS Hands-on Training Dates (not live surgery)

OR

Surgery Observation Dates (live cases)

OR

Comments

Biometer
LenSx Cataract
LenSx Flap
LenSx Pockets
LenSx Tunnels
ORA
Verion DML
Verion DMM
Verion Reference Unit
VLynk
WaveLight Allegretto Eye-Q (400Hz)
WaveLight Allegretto Wave (200Hz)
WaveLight Analyzer II
WaveLight Contoura
WaveLight EX500
WaveLight FS200
WaveLight FS200 Pockets
WaveLight FS200 Tunnels
WaveLight Oculyzer II
WaveLight Topolyzer VARIO

CLINICAL TRAINING REQUEST FORM