FAST TRACK CATARACT REFERRAL FORM
Please fill in the four mandatory fields (denoted by the red asterisk *): the patient's name, phone number, side of cataract and referrer details, then click SUBMIT. The remaining fields are optional. Forward clinical photos, scans and results in the UPLOAD FILE box (optional)
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
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.
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.