Name
Full name - i.e. as you would like to be recognized on articles you contribute to. Include relevant degrees.
Location
City, State, Country (e.g. San Francisco, CA, USA)
Affiliation(s)
Where you practice medicine – the name of the practice, clinic, hospital or other organization where you work as an ophthalmologist or are being trained in medicine. Separate multiple affiliations with a comma.
List or describe any financial disclosures. If you have nothing to disclose, please enter "None".
(optional) Public e-mail or contact
I am an ophthalmologist or an ophthalmology resident (PGY1+)?
Yes
No
Subspecialty
Enter your ophthalmology subspecialty, e.g. Comprehensive, Cataract, Cornea, Glaucoma, Neuro-ophthalmology, Oculoplastics, Pathology, Pediatric Ophthalmology, Refractive Management, Retina, Uveitis, etc.
Degree type
Name the specific degree that you hold that qualifies you to practice medicine -- such as M.D., D.O., MBBS, etc.
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