Dr Vincent Lee
  • Home
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    • Vision Correction Solutions >
      • Over 40s Vision Correction
      • Refractive Lens Exchange
      • Intraocular Collamer Lens ICL/ Phakic IOL
      • Multifocal and Toric Intraocular Lenses
      • ASLA/ PRK
      • LASIK
    • Cataracts >
      • Cataract Surgery
    • Glaucoma
    • Laser Floater Treatment
    • Dry Eye Laboratory
    • Macular Degeneration
    • Diabetes
    • Retinal Vein Occlusion
    • Oculoplastic Surgery
  • Information
    • Structure of the Eye
    • Eye Conditions
    • Self Help
    • Your visit to the clinic
    • Procedures
    • Postoperative Instructions
    • Collaborative Care
    • COVID-19 Infection Control
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    • Ask a question
  • Referrals
    • FAST TRACK Cataract Referral

FAST TRACK CATARACT REFERRAL FORM

This form facilitates fast track referral of patients for cataract surgery.

For convenience, note that apart from your referrer details, there are only three other mandatory fields: the patient's name, phone number and side of cataract (right or left). The remaining fields are optional and can be left blank. Click on the UPLOAD FILE box below to forward clinical photos, scans and results.

Mandatory fields are denoted by the red asterisk *
Fields are provided to specify public/ private surgery preferences. For patients who have specific visual requirements, a section is provided where refractive details can be provided to assist in determining refractive outcomes.
Thank you for your referral and we look forward to any feedback you may wish to send us, via our ASK A QUESTION FORM
Note: This Referral Form uses SSL security protocol for encryption of data transmission

    Patient details (only name and phone number are required):

    We'll try to accommodate your request, but if we can't give you an appointment at the time and date you specify, we'll do our best to offer you the next best option

    Referral details (required):

    Referrer's details (required):


    THIS SECTION BELOW RELATES TO THE PATIENT'S REFRACTIVE DETAILS, COMORBIDITIES AND PREFERRED REFRACTIVE OUTCOMES. THE SECTION CAN BE LEFT BLANK (scroll down and click the SUBMIT button)

    PREOP REFRACTION (Optional) select drop down options or enter manually the last field in this section below:


    POSTOP REFRACTION (optional)

    FILE UPLOAD
    Max file size: 20MB
    Save a scan or take a picture of your patient's corneal topography and click the button to find the file on your device. Then click the SUBMIT button!
    Max file size: 20MB
    Save a scan or take a picture of your patient's Macular OCT and click the button to find the file on your device. Then click the SUBMIT button!
    Max file size: 20MB
    Save a scan or take a picture of your patient's scan/ file and click the button to find the file on your device. Then click the SUBMIT button!


    Max file size: 20MB

Submit
Lifestyle Vision Questionnaire (Optional)
The questionnaire below can be printed and given to your patient for completion. Submitting the completed form will help us decide the best postoperative refractive state to match your patient's eye condition, lifestyle and aspirations, where possible.

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  • Home
  • Services
    • Vision Correction Solutions >
      • Over 40s Vision Correction
      • Refractive Lens Exchange
      • Intraocular Collamer Lens ICL/ Phakic IOL
      • Multifocal and Toric Intraocular Lenses
      • ASLA/ PRK
      • LASIK
    • Cataracts >
      • Cataract Surgery
    • Glaucoma
    • Laser Floater Treatment
    • Dry Eye Laboratory
    • Macular Degeneration
    • Diabetes
    • Retinal Vein Occlusion
    • Oculoplastic Surgery
  • Information
    • Structure of the Eye
    • Eye Conditions
    • Self Help
    • Your visit to the clinic
    • Procedures
    • Postoperative Instructions
    • Collaborative Care
    • COVID-19 Infection Control
  • About
    • Technology
  • News
  • Contact
    • Ask a question
  • Referrals
    • FAST TRACK Cataract Referral