Halo Order Request Form

Contact our Client Services team to place your order for Halo sterile tissues

Halo Request Form

  • Surgeon Information

  • Surgery Information

  • Date Format: MM slash DD slash YYYY
  • :
  • Patient Information

  • Date Format: MM slash DD slash YYYY
  • Halo Tissues

  • TISSUE  SHAPE WHOLE/HALF THICKNESS SIZE PRODUCT
    Cornea Half Half 8.5mm HCO-HH1
    Cornea Full Half 9.5mm HCO-FH2
    Cornea Full Full 9.5mm HCO-FF3
    Sclera N/A N/A 10mm x 10mm HSL-NA2
    Sclera N/A N/A 10mm x 10mm HPE-NA1

  • Please enter your desired quantity of each product displayed in the table above according to its corresponding product number.