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Referral and Authorization Forms
Please click the links below to download our Referral and Authorization Forms.
For patients referred for Keratoconus, please send the following to help us demonstrate progression for insurance approval:
- K values – all available K values from the last 5 years
- Manifest refractions – all available refractions from the last 5 years
- Clinic notes – all notes that document or support disease progression
Information Authorization Form
Fax Numbers | |
Sioux Falls | (605) 371-7035 |
Fargo | (701) 639-7199 |
Omaha | (402) 401-6420 |
Bozeman | (406) 624-6560 |
Alexandria | (320) 762-8898 |
Billings | (406) 294-1996 |
South Sioux City | (531) 625-3940 |
Cedar Rapids | (319) 362-0655 |
Northern Colorado | (970) 582-1176 |