Get Referral Form - Cincinnati Eye Institute

Filling out the Referral Form for the Cincinnati Eye Institute online is a straightforward process that can help facilitate necessary medical evaluations and treatments. This guide provides step-by-step instructions to ensure that all required information is accurately completed.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Referral Form and load it in your document editor.
2. Begin by entering the requestor's name in the designated field. This is the person initiating the referral.
3. Next, provide the requestor's phone number and address to facilitate communication.
4. In the patient information section, enter the patient's name and date of birth (DOB). This helps to ensure that the referral is correctly associated with the intended individual.
5. Specify the appointment date and time to indicate when the evaluation is scheduled.
6. Include the patient's phone number for contact regarding the appointment.
7. Indicate the type of consultation requested by selecting one or more options from the list, which includes conditions such as cataract, glaucoma, and neuro-ophthalmology.
8. If relevant, detail any other ocular diagnoses currently being treated by the referring doctor in the provided section.
9. Fill in additional patient information, including best visual acuity, refraction, intraocular pressure, and ocular medications, as applicable.
10. Provide any pertinent findings under the categories of anterior and posterior segments.
11. If any additional information is enclosed, mark the appropriate section to indicate this.
12. Confirm whether co-management was discussed with the patient and recorded by signing in the designated area and entering the date.
13. Once all sections are completed, save your changes, then download or print the form for submission. Ensure it is mailed or faxed to the appropriate office as indicated on the form.

Complete your documents online to streamline the referral process.