Referring Doctors

Florida Eye Specialists stand and smile as a group

Referral Form

Was previously the downloadable OD form "FES_ReferralPad-Locations_Feb23_PRINT"

Date of Birth(Required)
Referring Doctor Address(Required)
Our Doctors
Drop files here or
Max. file size: 128 MB.
    To ensure that your patient referral is scheduled successfully, we request that you attach the most recent office exam, visual field, and insurance card. These documents are crucial for our team to assess the patient's condition accurately and determine the appropriate course of action.