The Auro AMserter Project
The sutureless amniotic membrane inserter
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Request booking for AMserter  
To receive AMserter sample devices please enter your basic details below
Full name *
Postal address *
(Your sample devices will be mailed to this address)
Your primary place of work *
(Name of institution & address)
Your designation
Mobile number *
(It will be used only to contact you in an emergency)
Alternate mobile/land line number
(Optional)
Email ID *
I have been informed and am aware that in exchange of the device samples I am expected to share basic data about my usage scenario (indication), patient demographics (not identity), usage difficulties, outcome, patient photographs, and suggestions for improvement. I am also aware that this data will be used for device design enhancement and publication in any journal that the device inventors may choose. (I will be acknowledged for my contribution in all publications and presentations.)
Please check the check box to the left as a sign of your agreement. If you do not agree, please do not proceed with submission of this form by clicking the submit button below.