Old Dominion
Eye Foundation

 
HOME CONTACT ODEF MD SERVICES HEALTHCARE SERVICES MORE INFORMATION

Please complete the information below. Indicate if you would like more information or personal contact from one of our staff via E-mail, telephone or postal mail. Also, please feel free to leave comments below. Thank you for visiting our web page.
 

Full Name
Title
Organization
 
Address
City
State:
Zip:
Phone:
 
Fax Number:
E-Mail Address:
Comments:

 

1. I would like the following information sent to me:
    Information on Eye Donation
   Give the Gift of Sight donor card brochure
   Corneal Transplantation and You (A Patient Reference)
   "Eye Opener" Newsletter
   "Life beyond Loss" Booklet

 
2. I have the following requests/questions that I would like have addressed
    Schedule a Speaker for a Presentation to my Organization, Church, Civic Group, etc.
    Talk to Someone who has undergone a Corneal Transplant so that I can learn more about what to expect in surgery
    Talk to the Branch office Coordinator/Manager about scheduling programs/inservices in my facility
    Other    
 

3. I would like to hear from the Eye Foundation via (Please include this information above):

   Phone
   E-Mail
   Post-Mail
   FAX