If you are an ophthalmologist, neuro-ophthalomologist, neurologist, physiatrist or optometrist and would like to help patients restore neurological vision loss and become a pioneer in the field of neuroscience, complete the form below to be added to our physician directory which is accessible to prospective VRT patients who may be seeking an evaluation or a VRT prescription. Please note that directory information is subject to approval and will be verified to a degree.
Physician Information
First Name
Middle Initial
Last Name
Suffix
Specialty
Name of Practice
 
Office Information
Office Address
Suite
City
State
Zip
Phone Number - -
  Fax - -
Website
Email
  Verify Email
Physicians in Practice
No. of Physicians
First Physician
Second Physician
Third Physician
 
 
 
General Description of Practice