Referral Forms for Medical Professional Use

When to refer to a doctor of optometry

Prompt recognition and appropriate referral of ocular emergencies are essential in the primary care setting when the outcome may depend on timely management. All ocular emergencies, including a penetrating globe injury, retinal detachment, central retinal artery occlusion, acute angle-closure glaucoma, and chemical burns, should be referred immediately to an eye care professional. Clinics generally reserve a few appointments per day for medically necessary referrals. They have the proper knowledge, tools and equipment necessary to diagnose, treat or refer to a specialist (if needed). 

A list of examples of medically necessary conditions, with ICD9 Codes, is here.

To find a doctor of optometry near to your patient, use the Find an Optometrist link in the top left corner and enter the patient's postal code or the optometrist's name you wish to refer to.

For additional information regarding medically necessary services, please call (780) 451-6824.

Once the referral form is downloaded to your desktop it will become a fillable form and easy to use, print or email/fax.