Get Optometrist Referral Form

Filling out the Optometrist Referral Form online is a straightforward process that ensures patient information is accurately collected. This guide will provide you with clear instructions to complete each section of the form effectively.

Follow the steps to fill out the form with ease.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling out the patient contact details. Enter the title, email, and mailing address. Ensure that the suburb, postcode, and state are correctly filled in.
3. Next, provide patient clinical details. Include the first name, surname, date of birth, and contact information such as mobile and phone numbers.
4. Specify the assistance requested, such as wheelchair accessibility or a language interpreter. If applicable, indicate the specific language required.
5. Select the client's appointment preference based on available times. You can indicate your choice by ticking the appropriate boxes for days and times.
6. Provide details regarding the patient's clinical condition. Include pertinent exam findings, whether the patient is under ophthalmological care, and if so, the name of the ophthalmologist and the conditions treated.
7. Choose either Option 1 or Option 2 for the specific referral needs. For Option 1, select individual tests related to imaging and visual function services. For Option 2, select the ocular conditions requiring assessment.
8. Complete the referring practitioner's details, including the Medicare provider number and date before signing the form.
9. Once all sections are filled out accurately, save any changes. You may also download, print, or share the completed form as needed.

Complete and submit your Optometrist Referral Form online today.