Simple Ways to Submit an Online Referral:
NEW! SHARED DASHBOARD
Introducing our new shared HIPAA-secure referral dashboard via Phreesia. Your team can easily submit new referrals, track past referrals, attach important patient documents, receive live status updates, and utilize a 1:1 chat feature to quickly communicate with one of our scheduling representatives, all without ever faxing or picking up the phone!
Fill out our Online referral form, submitting an online appointment request instantly.
PRIOR ONLINE REFERRAL FORM
Do you still want to use our previous online referral form? Its not gone yet.
If you prefer to continue to fax or email referrals, download the attached Patient Referral Form, fill out all fields, and send it along with the required patient documents: exam notes, imaging: OCT/FA, demographics, and copy of patients’ insurance cards.