Referral and Authorization Forms

Refer a Patient Online, Phone or Fax - whichever you prefer
 

Online Referring

Submit your referral securely in minutes—complete our form or simply upload your chart notes and patient information. Click the link below. 

TO REFER BY FAX

Please click the links below to download our Referral Form

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