Referrals

Referring a patient is simple!

Either download and fax us the form below, or fill out and submit the form on the right!

We will contact the patient for you so you do not need to set the appointment up.

Please fax us over any relevant clinic notes from your evaluation, especially if you performed any imaging or visual fields testing.

Here are the faxable referral forms. Feel free to print them out and fax them to us if you prefer this method.

• Eyecare referral form

• Allied health care provider referral form
  
  

Our fax number is: 346-352-9156

Please hold off/refrain from dispensing a glasses or contact lens prescription, as the prescription may need to be adjusted following our functional vision evaluation.

​​​​​​​If we write a new prescription we will advise that the patient fills that at your office!