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    Pharmaceuticals Order Form

    Thank you for choosing to order your pharmaceutical needs via our online ordering system. In order to use this form you will need an account with Optimed. If you do not have an account please complete our online application form or phone our office on 1300 657720.
    Name*
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    Practice Name*
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    Practice Address*
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    Email Address*
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    Purchase Order Number
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    Store # if applicable
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    Please insert desired quantities in space provided. To see a more detailed explanation of these goods please download our pharmaceuticals listing available in the product menu
    I require an esky to keep goods cool*

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    Mydriatics and Cycloplegics
    Atropine 1%
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    Cyclopentalate0.5%
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    Cyclopentalate1.0%
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    Phenylephrine 2.5%
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    Phenylephrine 10%
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    Tropicamide 0.5
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    Tropicamide 1.0%
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    Mydriacyl 0.5%
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    Mydriacyl 1.0%
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    Cyclogyl 1.0%
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    Pilocarpine 2%
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    Local Anaesthetics
    Amethocaine 0.5%
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    Amethocaine 1.0%
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    Oxybuprocaine0.4%
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    Alcaine
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    Fluorescein 1%
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    Fluorescein 2%
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    Lignocaine 4% Fluorescein0.25%
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    Miotics
    Antibacterials and Miscellaneous
    Chloramphenicol
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    Prednisolone 0.5%
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    Predneferin Forte
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    Artifical Tear Gel 10g
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    Medical Swabs (200)
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    OptiStrips FL 100
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    Optistrips FL 300
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    Sterile Tear Flow Test Strips
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    Schirmer Tear Test with Blue Mark
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    Rose Bengal
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    Lissamine Green strips
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    Dry Eye Products
    Xailin Hydrate
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    Hyermellose 0.3% in a 10 ml bottle

    Xailin HA
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    Sodium Hyaluronate 0.2% in a 10 ml bottle

    Xailin FRESH
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    0.4 ml x 30. Carmellose Sodium 0.5%

    Xailin GEL
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    Carbomer 0.2% gel tube

    Xailin NIGHT
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    White Soft Paraffin 5g

    Blephex Tips
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    Blephadex Applicators
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    Blephadex Lid Wipes
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    Blephadex Foam Cleanser
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    Bruder Double Eye Masks
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    Bruder Single Eye Masks
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    EyeGenie Heat Applicators
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    Lacrimal lavage and Foreign body tools
    19g tapered to 23g lacrimal cannula
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    26g lacrimal cannula
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    5ml syringe - 100
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    3ml syringe - 100
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    rubber tool for removing foreign bodies
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    Anything else you would like?
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