Materials Catalog
Referral Forms and Guidelines
All Locations
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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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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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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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