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Patient Story Submission

Thank you for your interest in sharing your story on the Academy's EyeSmart website. Your story could help educate the public about eye diseases and conditions and other risks to eye health.

Use the form below to tell us a little about yourself, your eye condition, the treatment you received and how your sight is today.

A member of the Academy's public relations team will contact you for interview if your story is chosen for publication.

On many mobile devices, you can swipe left to get started with the form.

If you are under age 18, your parent or legal guardian must submit for you.
This question requires a valid email address.
Tell us about your eye condition and how an ophthalmologist helped you with it. What do you think would have happened had you not been diagnosed or treated by this ophthalmologist? When did you last see this ophthalmologist?
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