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Referral Forms and Guidelines

All Locations

Consultation Request—for cataracts and other conditions

Fill-in-the-blank referral form for cataract surgery, micro invasive glaucoma surgery (MIGS) at the time of cataract surgery, medical conditions, and other surgical procedures. NOTE: MIGS is not available in our Albuquerque, Anchorage and Olympia offices.

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Corneal Cross-linking Referral Form

Fill-in-the-blank form with information we request from your evaluative exam.

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Diagnostic Services Request—Albuquerque, NM

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Diagnostic Services Request—Anchorage, AK

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Diagnostic Services Request—Bellevue, WA

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Diagnostic Services Request—Bellingham, WA

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Diagnostic Services Request—Boise, ID

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Diagnostic Services Request—Chehalis, WA

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Diagnostic Services Request—Great Falls, MT

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Diagnostic Services Request—Kennewick, WA

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Diagnostic Services Request—Lewiston, ID

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Diagnostic Services Request—Olympia, WA

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Diagnostic Services Request—Portland, OR

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Diagnostic Services Request—Silverdale, WA

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Diagnostic Services Request—Spokane, WA

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Diagnostic Services Request—Tacoma, WA

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Diagnostic Services Request—Tualatin, OR

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Diagnostic Services Request—Vancouver, WA

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Diagnostic Services Request—Yakima, WA

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Glaucoma Surgery Referral Form—Albuquerque, NM

For selective laser trabeculoplasty (SLT).

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Glaucoma Surgery Referral Form—Bellingham, WA

For selective laser trabeculoplasty (SLT) and micro invasive glaucoma surgery (MIGS, which includes iStent) at the time of cataract surgery.

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Glaucoma Surgery Referral Form—Chehalis, WA

For selective laser trabeculoplasty (SLT), micro invasive glaucoma surgery (MIGS, which includes iStent) at the time of cataract surgery, filtration surgery and cyclophotocoagulation.

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Glaucoma Surgery Referral Form—Kennewick, WA

For selective laser trabeculoplasty (SLT) and micro invasive glaucoma surgery (MIGS, which includes iStent) at the time of cataract surgery.

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Glaucoma Surgery Referral Form—Tacoma, WA

For micro invasive glaucoma surgery (MIGS, which includes iStent) at the time of cataract surgery, cyclophotocoagulation, selective laser trabeculoplasty (SLT) and trabeculectomy.

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KAMRA Corneal Inlay Referral Form

For presbyopia correction at our Bellevue office.

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Laser Vision Correction Enhancement—after 2+ years

Information we require from your evaluative exam.

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Laser Vision Correction Referral Checklist

To help ensure that all the referral details have been completed.

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Materials Request Form

To request materials we have produced for use in your practice.

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Presbyopia-correcting Lens Implant Referral Checklist

To help ensure that all the referral details have been completed.

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Refractive Surgery Referral Form

Fill-in-the-blank form with all the information we require from your evaluative exam.

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