* Please fill in contact details for correspondence:
For retinal emergencies please call 0407 381 971
Dr T . Justin Playfair Surgical & Medical Retina Specialist
MB BS( Hons) FRACS FRANZCO
Dr Timothy Nolan Ophthalmic Surgeon
Medical Retina & Macula Specialist MB BS(Hons) MSc FRANZCO
Dr Jed Lusthaus
Ophthalmic Surgeon Cataract and Glaucoma Specialist
MBBS (Adel) MPH (Syd) FRANZCO
Dr Michael Chilov Ophthalmic Surgeon
Medical Retina & Macula Specialist B.Optom(Hons) MB BS(Hons) MPH FRANZCO
A/Prof I-Van Ho Surgical & Medical Retina Specialist
MB BS PhD FRANZCO
Patient Name
Date of birth
Clinical information
Dr Adrian Fung Surgical & Medical Retina Specialist
MB BS( Hons1) MMed(Ophthal Sci.) FRANZCO MMed(Clin. Epi.),
Dr Matthew Simunovic Medical Retina Specialist
MB. BChir, PhD, FRANZCO
Vitreoretinal Surgeon
Cataract, Medical Retina, Glaucoma and
Uveitis SpecialistB.Sc(Hons) MBBS FRCOphth FRANZCO
Dr Richard Symes
:
:
Referring Doctor / Optometrist
Name:
Address:
Telephone: Provider No: Signature: Date:
Eastern SuburbsEye Specialists
Park Place, Suite 901, Level 9 3 Waverley Street, Bondi Junction NSW 2022
Ph: (02) 9389 4840Fax: (02) 9387 8541
For your appointment
* Please bring current glasses * Please bring a list of any medications and any allergies * Name of your GP and Optometrist (full address & phone number) * Please bring Medicare / Health Fund / Pension card/s
We are here
Bondi Junction Railway Station
Eastern SuburbsEye Specialists