Get Optometry Referral Form

This guide provides step-by-step instructions for completing the Optometry Referral Form online. Whether you are a healthcare professional or assisting a patient, this comprehensive guide will ensure you fill out the form accurately and efficiently.

Follow the steps to complete the Optometry Referral Form online

1. Click ‘Get Form’ button to access the Optometry Referral Form online.
2. Begin by filling in the optometrist details. Include your name, GOS personal code, and practice address.
3. Next, enter the general medical practitioner (GP) details. Provide the name and practice address of the GP to whom you are referring the patient.
4. In the patient details section, enter the patient's surname, first name(s), health and care number, date of birth, address, postcode, and telephone number.
5. Record the date of the eye examination and indicate whether LES level II enhanced case finding was provided.
6. In the symptoms section, indicate if the patient is symptomatic or asymptomatic. Provide additional details as necessary.
7. Fill in the refraction and IOP details, including the unaided vision measurements for both eyes, the date, and the method of IOP measurement.
8. Complete the optic nerve and disc analysis, providing information about the V C:D ratio, disc characteristics, and any disc hemorrhage, if applicable.
9. Indicate any relevant findings or medical history that may aid in the referral, ensuring to include reasons for referral related to IOP, angle, and visual fields.
10. Provide additional relevant tests and measures undertaken, such as visual fields, fundus imaging, or any other pertinent assessments.
11. Select the appropriate copies to send, ensuring that the white copy is designated for the clinic, the blue copy for the GP, and the yellow copy for patient records.
12. Finally, review all fields for accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your Optometry Referral Form online today for a streamlined process!