Alcon Account #
*
Clinic / Facility Name
*
I acknowledge I have read and understood the contents of this notification letter.
*
Yes
Name of Responder (First and Last)
*
Contact Email
*
Contact Phone Number
*
Number of Units to discard:
*
Indicate below how you will contact patients to whom you have transferred or distributed the identified lots, informing them this Voluntary Medical Device Recall and instructing them to dispose of contact lenses from the identified lots. Please select all that may apply.
For MARLO accounts, I will opt-in to the MARLO patient notification service
I will notify patients directly
SUBMIT