First Name * Last Name * Address 1 * Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Who is your Ophthalmologist or Optometrist? * - Select -Allen R. Pearce, MDAnnette M. Rhodes, MDCandace C. Collins, MDCharles E. Afeman, MD, FACSCrayton A. Fargason, MDDavid P. Fargason, MDFay L. Woo, MDGeorge D. Fivgas, MD, FACSDaniel J. Dodson, MDH. Michael Haik Jr, MD, FACSDaniel H. Nelson MDMichael Abbott, ODPhilip D. Ehrlich, MDR. Lucas Patin, ODLaurén Luckett Dardar, ODShaye Luckett, MDThomas J. Heigle, MDDevin B. Tran, MDJamie L. Hatcher, MD Zip * Phone * Email * Date of Birth * Are you a patient of EMC? * Yes No Comments *
