Practice Opportunities Network - Seeker Form

To list your information, please complete the form below:

* required field

Contact Information:

Name: *
Email address:

Current Address:

Street address:
City, State/Province:		, Select... AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY
Zip/Postal Code:
Phone:

Permanent Address:

Street address:
City, State/Province:		, Select... AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY
Zip/Postal Code:
Phone:

Other Information:

Month/year available:		1 2 3 4 5 6 7 8 9 10 11 12 2008 2009 2010 2011
School/College of Optometry:

List other degrees or awards:
Position desired: (check all that apply)

Employment		Associateship		Associateship leading to partnership
Partnership		Practice for sale		Group/health maintenance
Education		Public health		Civil service
Other:

Specialty interests: (check all that apply)

Primary care	Pediatrics	Geriatrics	Ocular disease
Contact lenses	Vision training	Low vision
Other:

If you have questions, or would like to update your listing, please call:
Mark Wright at (614) 292-2788 or send an email.

© 2009 College of Optometry
The Ohio State University
338 W. 10th Ave
Columbus, OH 43210-1280

Admissions: (614) 292-2647 or (866) 678-6446
Clinic: (614) 292-2020

If you have trouble accessing this page and need to request an alternate format, please contact the College of Optometry Webmaster.