FAST TRACK CATARACT REFERRAL FORM

This form facilitates fast track referral of patients for cataract surgery, either in a public or private hospital. Fields are provided for preferences to be specified for public/ private surgery and refractive outcome. These are optional.

Note that, apart from your referrer details, there are only three other mandatory fields: the patient's name, telephone number and reason for referral. The remaining fields are optional. Click on the UPLOAD FILE box below to forward clinical photos, scans and results. 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

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Patient details (only Name and Phone number are mandatory):

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

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