Thank you for entrusting us with the care of your patients. Please include any relevant history, photographs, or lab results as an attachment to this form. A printable version of this form is available here.
If faxing, no cover sheet is necessary and we ask that information sent be relevant only to the eyes. Thank you!
If this is an emergency, please call us at (615) 690-9399 for a consultation. We are not an emergency facility and are not set up to accept walk-ins.
We will contact your patient to schedule an appointment once the referral is received and we have had a chance to review it.