Patient Referral Forms

Find the correct patient referral forms below.

We happily reserve appointments for optometrist and medical doctor referred patients to ensure your patients are seen as quickly as possible. The physicians and staff at Empire Eye Physicians are also happy to communicate with your office to make sure you know our findings and treatment plan for your patient. To easily refer patients, please fax the appropriate form(s) below to 509.928.0784 or you, your staff or the patient may call our office at 509.928.8040.

Find our various patient referral fill-in-the-blank forms below. To complete, please download each needed form, complete, print, then fax the completed document(s) to 509.928.0784.

Consultation Request Fill-In Form

Cataract Consultation Request Fill-In Form

Corneal Cross-Linking Consultation Request Form

Dry Eye Consultation Request Fill-In Form

Refractive Enhancement Consultation Request Fill-In Form

Refractive Surgery Consultation Request Fill-In Form

Refractive Surgery Post-Operative Report Fill-In Form

Refractive Surgery Quick Summary Form

Cataract Surgery Post-Op Report Fill-In Form

YAG Laser Post-Op Report Fill-In Form