Order Forms

Eschenbach’s Haus Call is a first-of-its kind Telelowvision Program that allows you to easily offer low vision care to your patients who are either unable or hesitant to visit you in person. This unique at-home service allows you to conduct both a low vision exam and a follow-up device assessment appointment virtually.

This is possible through the use of our two exclusive kits (the iDoktor and iProdukt) that are sent directly to your patient before your scheduled virtual appointment, each kit including the option of an iPad with a pre-loaded link to a HIPAA-compliant web conferencing app. Fill in the form below to begin the ordering process.

Haus Call Telelowvision Forms:

Telelowvision Complete System: Order Form

Telelowvision Product Trial Kit: Order Form

Learn more about our Telelowvision Program HERE!

Custom Solutions Program allows for Eschenbach readers, absorptive filters and mounted telescopes be customized for your patients. To assist with the Custom Solutions ordering process, select the form below, complete the form and submit back to Eschenbach.

Custom Solutions Order Forms:

Custom Solutions Form - Eyewear

Custom Solutions Form - Illuminated Readers

Custom Solutions Form - Absorptive Filters 

Custom Solutions Form - Eschenbach Telescopes

Custom Solutions Form - Designs for Vision Telescopes

Simply click on the correct order form and fill it in. Then follow these instructions to submit:

1) Save the completed form onto your computer and email it to customerservice@eschenbach.com

2) Print out and fax it to (888) 799-7200

3) Print out the completed form, scan it and email it to customerservice@eschenbach.com

To learn more, download our Custom Solutions Catalog!