Request repeat prescription

Every patient receives a medication package via Visus Oogkliniek on the day of treatment. This is enough to drip for the first few weeks after your treatment.

If you then need a repeat prescription for your drops, you can fill in the information below. We will send a repeat prescription to your pharmacy the next working day. You can pick up the drops from your pharmacy at the end of that day. Repeat prescriptions can only be requested by patients in the Netherlands.

Patients outside the Netherlands can do this through their own GP or buy artificial tears in the store without preservatives.

Request form

- Firstname*
- Surname*
- Street*
- House No.*
- Addition
- Postal code*
- City*
- Date of birth*
  
  DD
  MM
  YYYY
- Email address*
- phone number*
- Name pharmacy*
- Location pharmacy*
- Mail Pharmacy*
- Fax Pharmacy*
Make your choice
Quantity in box
- Hylan e.d.o.
  Please enter a number less than or equal to 4.
- Vidisic e.d.o.
  Please enter a number less than or equal to 4.
- Oculotect unidose
  Please enter a number less than or equal to 4.
- Celluvisc
  Please enter a number less than or equal to 4.
- Artelac e.d.o.
  Please enter a number less than or equal to 4.
- Artelac flesje
  Please enter a number less than or equal to 4.
- Vidisic carbogel tube
  Please enter a number less than or equal to 4.

Request repeat prescription

Request form

Make your choice

Make an appointment at our clinic without any obligation

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Request repeat prescription

Request form

Make your choice

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