Glycocheck Purchase Form

GlycoCheck Purchase Form

Thank you for your decision to purchase GlycoCheck. Please complete the following form. This information will be used for delivery. It is important that you check this for accuracy. All fields are required.

GlycoCheck Purchase Form

"*" indicates required fields

Check which system you are purchasing:*

Academic Researcher

Healthcare Practitioner

Institution/Practice Name:*

Contact Name*

Billing Address*

Shipping Address

Email*

Phone*

VAT Exemption Number (use NA if not applicable)

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Special Instructions

Upon receipt of your information, we will generate an invoice that will be emailed to you. Upon receipt of your payment, we will ship your order.

Contact MicroVascular Health Solutions, the exclusive worldwide distributor of GlycoCheck, for a demonstration.
Reorder Disposable Lens Covers using this form
1.800.227.1933

In Japan, please contact our affiliate
Finggal Link Co., Ltd.
03-6802-7145
03-6802-7156