Alcon Experience Academy

Welcome to the Alcon
Experience Academy

CLINICAL TRAINING REQUEST FORM

To schedule clinical training at your center, complete the following form and submit to Alcon for processing.

Center Details

Center Name *

Country *

Street Address *

City *

State / Province *

Postal Code *

Center Contact Name *

Center Contact Email *

Center Contact Number *

Center Details

Has Surgery Center Been Reserved for the Dates Provided?

Same as Above

Surgery Center Name *

Country

Street Address

City

State / Province

Postal Code

Center Contact Name

Please enter a contact name

Center Contact Number

Trainee Details

Number of Surgeons *

Select Number of Technicians to be Trained *

Number of Eyes Scheduled *

Alcon requires a minimum of 5 eyes scheduled for LenSx and ORA to schedule an Alcon CAS; Alcon requires a minimum of 6 eyes scheduled for WaveLight to schedule an Alcon CAS.

Hands-on Didactic Dates (Phase II)

Surgery Observation Dates (Phase III)

Comments

Welcome to the AlconExperience Academy

CLINICAL TRAINING REQUEST FORM

Center Details

Center Details

Trainee Details

Products

Welcome to the Alcon
Experience Academy