Order Request Form

Thank you so much for your interest in AXIM Eye point-of-care diagnostic tests. To process your order, federal regulations require that we have a copy of your current CLIA certification. Please provide AXIM Eye with the requested information on the form below and you will be contacted by AXIM Eye to complete the ordering process.

*For more information on CLIA certification and the requirements needed to purchase and use AXIM Eye Diagnostic tools CLICK HERE.