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Application for Your FREE Membership

Step 1 of 2: Enter your data

If you are not yet a member of palpebra.com, you can register as a palpebra specialist for free using the form below. The information you enter can be updated later anytime. Your registration and updates will be reviewed by palpebra.com admins.

 

Last name

OMIT academic titles

 First name

OMIT academic titles

 

E-mail address

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Profession

Eyelid Surgeon

Ocularist

 

Password of your choice

 Repeat password

 

 

Website URL (homepage, optional)

 

Home city (=head office)

 

Home country

 

Also, sometimes I practice in the following cities ...

(multiple entries allowed, please separate by comma,
do not enter additional comments)

 

... and in the following countries:

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hold down Ctrl and click the mouse on the countries
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I speak the following languages:

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Profile image

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portrait format or square, no landscape format)

 

You can only become a confirmed palpebra specialist, when at least two existing palpebra specialists confirm your application. Please select two references, who will likely confirm your application. These references are in no way responsible or liable towards doctors, patients or palpebra.com. The references cannot be updated once your application has been sent.

 

First reference

 

Second reference

 

Both references will be informed about your application automatically and can confirm your application electronically. As long as your application has not been confirmed by both of your references, your entry will be displayed in palpebra.com including a note that it is yet unconfirmed.

 

For eyelid surgeon registration I ensure, that I have completely secluded human medicine studies and an ophthalmological residency with all obligatory diplomas; a primary focus is on oculoplastic surgery. For ocularist registration I ensure, that I have completely secluded all requirements of the local education program with all obligatory diplomas.

 

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