Thank you for supporting the Ohio Amblyope Registry. If there is a change to your original registration information, please complete the form below.  If you have an additional office that you would like to list, please complete the form below and add a comment stating it's an additional office location.

Fields marked with an asterisk (*) are required.

Enter all information, including corrections.

Your email address is for communication purposes only and will not be visible in the registry.

Example: 614-555-5555 — don’t forget the area code

Example: 800-555-5555 — don’t forget the area code

Example: https://domain.com/

Comments are for internal use only and will not be visible in the Registry.