(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


Injector Size

Graft Size


Preferred Hinge


Helping THE PEOPLE OF HAWAi’I since 1961

Fighting against blindness & Working to Restore Vision.

(808) 536-7416


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