Get Low Vision Referral Form - The Chicago Lighthouse - Chicagolighthouse

Filling out the Low Vision Referral Form for The Chicago Lighthouse is an essential step in accessing support for individuals experiencing low vision. This guide will provide a clear and comprehensive approach to efficiently completing the online form.

Follow the steps to accurately complete the referral form.

1. Press the ‘Get Form’ button to obtain the Low Vision Referral Form and open it in the online editor.
2. Begin by entering the patient's name in the designated field. Ensure the name is spelled correctly to avoid any confusion.
3. Input the patient's phone number for contact purposes. Providing a reliable contact number can facilitate scheduling and follow-up.
4. Detail the diagnosis or cause of vision loss in the appropriate field, which assists in determining the necessary services. Be as specific as possible.
5. Mark the difficulties the patient is facing in the tasks listed, such as near tasks, distance tasks, and others. Selecting the relevant options will aid in targeted assistance.
6. Provide the doctor's contact information including the address and phone number. This ensures seamless communication between the clinics and the referring doctor.
7. Indicate whether the patient will call for an appointment or if The Chicago Lighthouse should contact them for the same. It can help in managing appointments effectively.
8. Once every section is completed, review the information for accuracy. Save any changes made, and prepare the form for submission.

Get started by filling out the Low Vision Referral Form online to access the support you need.