These referral forms are for the use of AAO member optometrists. To access the VLRA & CNIB Referral & Resources and the OMD Information & Referral Forms you must sign-in to the members section of the AAO website.
A list of examples of medically necessary conditions, with ICD9 Codes, isĀ hereĀ .
VLRA & CNIB Referral & Resources
OMD Information & Referral Forms
Macular Evaluation Report Form
(Adobe PDF File)
Report of Dilated Fundus Exam Form
(Adobe PDF File)
Report of Ocular Visual Examination Form
(Adobe PDF File)
Eye Health Referral Form
(Adobe PDF File)