• PATIENT REFERRAL

  • REFERRING PROVIDER INFORMATION

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  • PATIENT INFORMATION

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  • REFERRAL INFORMATION

  • Co-Management Acknowledgement

    Following our evaluation, we will communicate any findings and/or treatment recommendations.

    If surgery is necessary please indicate below if you'd like to co-manage. Regardless, all patients will be sent back to the referring provider to resume general eye care as appropriate.

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