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 *
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
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.