My Certificates Read (full name)*
I like to be called as (nick name to be written on badge)*
I am Practicing Ophthalmology Since (years into practice)*
How comfortable you are with Trabeculectomy? * Very ConfidentSomewhat ConfidentJust started doing Trabeculectomy
How many Trabeculectomies have you done so far? *>5020-5010-20<10
Which step of Trabeculectomy you find most difficult?* Scleral flap constructionDeep block excisionConjunctival suturingothers
Any specific doubt you want to clear in this workshop? *
How many Trabeculectomies do you expect to do in a year after you attend the workshop? *<55-1010-20>20
Complete Mailing Address*
Phone Number *
Email Id*
Upload your resume*
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