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So that we may properly consider your request would you please provide the following information:

1. The Dove article title and citation*:

Cammack J, Whight J, Cross V, Rider A, Webster A, Stockman A. Psychophysical measures of visual function and everyday perceptual experience in a case of congenital stationary night blindness. Clin Ophthalmol. 2016;10:1593-1606https://doi.org/10.2147/OPTH.S99593

2. The graphic / image / figure / table to be extracted and re-used*:

3. Intended reuse*:

Congress/Satellite Event?Standalone/Product Launch Meeting?Product Detailing / Diagnostic Aid?Core slide deck / Reference materials?Continuing Medical Education (Certified/Accredited or Non-Certified)?Plenary event (non-promotional)?Advisory board / Steering group (non-promotional)?

4. The intended target audience*:

5. Has this request been made or supported by a pharma company?*:

YesNo

6. Name of any pharma company/organisation making the request and the country they are located in*:

7. The format for distribution - printed and/or digital*:

Printed and DigitalDigitalPrinted

8. The quantity for circulation*:

Number of copies if printed or number of views if digital

9. If republication, the New Article title*:

10. Are you an author of the New Article*:

11. Title of targeted journal*:

12. Publisher of targeted journal*:

13. Is the new article published under an Open Access license? If yes, please specify the type of license*: