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Wheaton Eye Clinic Order Form
WHEATON EYE CLINIC
WELCOME Wheaton Eye Clinic Professionals!
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Dr. Ruth Williams
Other Wheaton Physician
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Welcome Dr. Williams!
If you have an corrections, please do so below.
I am using this form to serve as my official DME Prescription for the iCare HOME tonometer for at-home RPM monitoring of my patients' IOP. -Dr. Ruth Williams, MD., Wheaton Eye Clinic, 2015 N Main Street, Wheaton, IL 60185 NPI: 1699764597 The results will be emailed to: ruthwilliams@wheatoneye.com
Your Name
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For official communication with MyEYES and Patient's HOME data results
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Would you like us to add you to the drop down list?
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Yes
Not at this time
This will make it easier referrals!
Would you like us to send you some HOME brochures for your patients?
Yes
To: Attn: Dr. Williams, 2015 N Main Street, Wheaton, IL 60185
Would you like us to send you some HOME brochures for your patients?
Yes
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