Ohio Eye Care Consultants - Patient Appointment Request

Dr. Thomas Chi, Dr. Amy Fernandez, Dr. Carrie Balthaser and Dr. Sara Prusinski

PATIENT APPOINTMENT REQUEST

Each doctor is available for appointments as follows:

Dr Thomas Chi, MD:
- Wadsworth Office - Monday 8-4 and Thursday 8-11
- Medina Office - Wednesday 2-4, Thursday 1-4, Friday 8-4
- Lodi Office - Every other Thursday 8-12 p.m.

Dr Amy Fernandez, OD:
- Wadsworth Office - Wednesday 8-4, Friday 8-4
- Medina Office - Monday 8-4, Tuesday 12-7, Thursday 8-4, Every other Saturday
- Lodi Office - Every other Thursday 1-5 p.m.

Dr Carrie Balthaser, OD:
- Wadsworth Office - Monday 9-4

Medina Office - Wednesday 12-7, Friday 8:30-3:30

To request an appointment, please fill out the form below. Please DO NOT use this form in the event of an emergency. Please call our office at 1-877-292-2020 if your situation requires immediate attention.

Full Name*
First Name: MI:
Last Name:

Phone* (Please enter at least one)
Home:
  Cellular:
  Work:

E-mail Address

Date / Time: (Please enter the days and times that you prefer.)
  1st choice:
  2nd choice:
  3rd choice:

Doctor*

Office Location*

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