Unlocking Excellence: Partner with ReFocus Eye Health

We welcome eye care professionals to join hands in delivering unparalleled patient care. Our interdisciplinary team, comprising seasoned specialists and surgeons, ensures comprehensive solutions for diverse eye conditions. When you refer your patients to us, you entrust them to a collaborative environment dedicated to precision, compassion, and innovative care.

Our commitment to excellence extends to maintaining open communication, ensuring a seamless transition of care, and fostering a shared commitment to optimal vision. Refer to ReFocus Eye Health and witness the difference firsthand.

Please fill out the form below to request a referral. You can also fax your referral requests to 844-512-2422.

Patient Information

First Name *

Middle Name

Last Name *

Date of Birth *

Sex

Female Male

Phone Number *

Alternate Phone Number

Insurance Company

Policy Number

Referring Office Information

Doctor First Name *

Doctor Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Practice Name

Phone Number *

Fax Number

Please send a follow up with appointment info

Fax Email

Appointment Request *

Priority (3-4 days) Non-Urgent (1-4 weeks)

Notes for Appointment (please include diagnosis and reason for visit): *

All information is stored securely and is HIPAA compliant

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