U.J. BERZINS, M.D.
ROBERT E. TIBOLT, M.D.
MARCUS A. EAST, M.D.
RYAN W. LAPOUR, M.D.
JOHN G. DODD, D.O.
ADAM T. SHUPE, O.D.
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
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