Get Omni Eye Referral Form

Filling out the Omni Eye Referral Form online is a straightforward process. This guide will walk you through each section of the form, ensuring you provide all necessary information accurately.

Follow the steps to complete the referral form effectively.

1. Press the ‘Get Form’ button to access the Omni Eye Referral Form and open it in your preferred online editor.
2. Fill in the referring doctor’s information, including their name, address, city, state, zip code, phone, and fax number. Ensure all details are accurate for successful communication.
3. Next, enter the patient's personal information, such as their name, address, city, state, and zip code. Also, include their phone number, email address, and date of birth.
4. Indicate the appointment status by marking whether the patient is scheduled at Omni or if Omni will be scheduling them. Provide any additional relevant notes as needed.
5. Select the reason for referral by circling the appropriate option, which may include categories such as retina, cornea, or glaucoma. If co-management is desired, specify this too.
6. Document any pertinent symptoms or medical history that may assist with the patient’s referral. Ensure the information is clear and concise.
7. Complete the clinical measurements such as best-corrected visual acuity (BCVA) and tonometry readings. Include the details for both eyes (OD and OS).
8. Specify any procedures you are specifically requesting by marking the corresponding boxes, such as anterior segment photos or visual field testing.
9. If you have a preferred doctor or surgeon, circle their name from the options provided. This will help indicate your preferences during scheduling.
10. Sign the referral form by adding your signature in the designated field, confirming the information provided is accurate and complete.
11. Finally, review all entered information for accuracy and completeness. Once confirmed, you can save the changes, download a copy, print it, or share the form as needed.

Complete the Omni Eye Referral Form online today for efficient scheduling and management.