(808) 536-7416 info@lebh.org

Tissue Request Form

FDA and EBAA regulations require that all tissue banks request pre-operative recipient information for all transplantable tissue.

Please fill out the form below to request a custom tissue.

For questions and more information contact (808) 536-7416.

Tissue Requested:

DSAEK Selection

Sclera Size

Cornea Size

Thickness

Injector Size

Graft Size

Mark

Preferred Hinge

Mark

Helping THE PEOPLE OF HAWAi’I since 1980

Fighting against blindness & Working to Restore Vision.

(808) 536-7416

info@lebh.org

405 N. Kuakini St. #801 Honolulu, HI 96817