For St Patrick's day, we would like to send your OM doctor, Oncologist, Opthamologist, Eye Doctor/clinic a special "Lucky Charm" appreciation certificate from you and from OMF. Please fill out the following...

* 1. Your Name and Email

* 2. Doctor's Name and Contact Information

* 3. (Optional) Tell us about your doctor. How did he/she make a difference in your OM journey?