Submit a Renu Contact Solution Claim

First Name:

Last Name :

Zipcode:

Email:

Home Phone:

Cell Phone:

Work Phone:

1. Have you suffered a permanent loss or change in vision?

I have suffered a permanent change or loss in my vision.

My vision is the same as before.

No response.

2. Are you still able to wear contact lenses?

I am able to wear contact lenses.

I can no longer wear contact lenses.

No reponse.

3. Were you using ReNu with MoistureLoc in the month prior to your eye infection?

Yes.

No.

4. I have been treated with:

Anti-fungal Drops.
Anti-fungal Ointment.
Antifungal Injection.
Steriod Eye Drops.
Eye Surgery.
Corneal Scraping.
Corneal biopsy.
Corneal debridement.
Ultrasound of eye.
Oral Antibiotic.

Please use this section to provide any additional information that will help us better understand your situation: