Registry Corrections | Ohio Amblyope Registry

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.

Original Page ID

Email Address

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

First Name

Middle Name

Last Name

Doctor Type

Practice Name

Street Address 1

Street Address 2

City

ZIP Code

County

Phone

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

Toll-Free Phone

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

Website

Example: https://domain.com/

Description

Comments

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