Board-Certified Ophthalmologist

Phone 503.581.5287  
Fax  503.386.1377  
RETURN TO WORK CERTIFICATION
This is to certify that:
has been under my professional care for
From
To
and has sufficiently recovered to be able to return to school or work as of
Remarks

Physician Signature
Medical Center Eye Clinic
655 Medical Center Drive NE
Salem, OR. 97301