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Referral Appointment Reminder
Patient’s Name:
Date of Birth: / /
An appointment has been made for you on:
Date: at am / pm
With: � Richard A. Erdey, MD � Gregory D. Searcy, MD � Daryl D. Kaswinkel, MD � Samuel A. Gallo, MD
Reason for consultation: � Cataract � Complicated Cataract – Suture fixated IOL � Laser Vision Correction / Implantable Contact Lens (ICL) � Keratoconus - Intacs � Cornea Transplantation - DSEK / DALK / PKP � Diabetic Eye Screening � Glaucoma Suspect / HRT Nerve Fiber Layer Analysis � Glaucoma Surgery: SLT, Trabeculectomy, Shunt - Ahmed / ExPress � Ptosis / Brow Lift / Blepharoplasty / Botox / Face lift � Tearing / Nasolacrimal Duct Obstruction � Thyroid-related Eye Disease � Lid Lesion � Other:
Referring Doctor:
Name:
Address:
Date: / /
See reverse side for directions and map
50 McNaughten Rd. Suite 200Columbus, Ohio 43213
614.863.EYES (3937)614.863.5010 (fax)
www.icanseeclearly.comemail: [email protected]
REV C9858 03/09
ERDEY SEARCY EYE GROUP50 McNaughten Road, Suite 200, Columbus, Ohio 43213
(614) 863.EYES (3937) (614) 863.5010 (Fax)
Directions to Our Office:From east side of outer belt, 270: Follow 270 North or South to Exit #39 and exit onto E. Broad St. Proceed east (towards Newark) past the first traffic light and continue past Mount Carmel East Hospital campus (on the right (south) side of street). Second traffic light (Walgreens on southwest corner), turn right onto McNaughten Rd. IMMEDIATELY on left (east) side of McNaughten Rd., you will see our two story building. Turn left into the parking lot behind (east side) the building and park.
From 670: Take 670 East to the 270 South exit. Once you are on 270 South, follow the directions above.
From I-70 East or West: Exit onto 270 North (on the east side of Columbus). Once you are on 270 N, follow the directions above.
From Newark: Westbound on E. Broad St., turn left onto McNaughten Rd. (Walgreens on southwest corner). Immediately on left (east) side of McNaughten Rd., you will see our two story building. Turn left into the parking lot behind (east side) the building and park.
East ColumbusSurgery Center
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East ColumbusSurgery Center
