Please complete this form in order for Minnesota Lions Eye Bank to assess your request for research tissue.

The Minnesota Lions Eye Bank will contact you regarding this request within two weeks of receipt (usually sooner). Please direct questions to Kathy at 612-626-4863.


Are you affiliated with the Department of Ophthalmology, University of Minnesota?

Is the research tissue going to be utilized by a for profit company?

Will the tissue be re-distributed to anyone else?

If this is an IRB study, please enter the number

Contact information of person who will be picking up the eye tissue:

If unable to pick up in person, please provide a shipping address:

Tissue criteria and preservation information

Tissue type (check all that apply):

If other, please specify

Does sterile technique need to be maintained?

Are serologies required?

Note: All preservation solutions and materials must be provided by the researcher