Referring Doctors

Specialty Contact Lenses

Medical Care

Thank you for allowing us to share in the care of your patients! In order to make their appointment proceed as smoothly as possible, please complete the referral form below and submit to us along with any supporting documentation and previous exam records. We will be happy to contact the patient directly to discuss the evaluation process or provide them with more details, as pertains to their unique needs.
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Referring Doctor

OD / MD

Patient Information

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Referal Reason

Please select:(Required)
Patient Care(Required)
Max. file size: 256 MB.
We will call your patient to schedule an appointment with one of our doctors within 2 business days of receiving this fax. You will receive a fax with progress notes on our evaluation and plan when your patient has been seen.