For Referring Providers

Refer a Patient

All referrals are reviewed the same day they are received and scheduled according to clinical need. For urgent cases, please call 210-615-7600 rather than using this form, and we will see the patient the same day.

Information for referring providers →

Your Office

Provider First Name*

Provider Last Name*

Practice Name (optional)

Office Phone*

Fax

Office Email

Provider Cell Phone (optional)

So our physicians can text/call directly for updates if desired.

Remember my office details on this computerOnly your office information is saved. Patient information is never stored.

Patient

First Name*

Last Name*

Patient Details

Demographics Sheet*

Drag a file here or browse

Insurance (optional)

If insurance is not included with demographics, .

Referral

How Soon Should the Patient Be Seen?*

Reason for Referral*

Location

Physician

Clinical Notes & Imaging (optional)

Drag files here or browse to upload

Referral letter, exam notes, OCT or fundus images

Fields marked * are required. Referrals are reviewed the same day.

Same-Day Referrals

For patients who need to be seen today, please call our office and we will arrange a same-day visit.

210-615-7600 Laredo 956-722-5200

Refer by Fax

San Antonio & New Braunfels

210-615-8505

Laredo

956-722-5250

What to Expect

Same-day review
All referrals are reviewed the same day they are received.
Scheduling by clinical need
We contact the patient directly to schedule.
Visit summaries
A clinical summary is sent to your office after every visit.
Direct communication
Leave your cell number and our physicians may text or call you with updates.