OPTOMETRIST REFERRAL FORM

Patient contact details

Assistance required

Patients preferred location

Unfortunately COVID-19 has affected our ability to open 2 of our clinics and only UNSW will be open until further notice. Sutherland and the Cameron Centre (Parramatta) are temporarily closed and all referrals should go through UNSW in the interim.

Patient clinical details

Acute referrals should not be sent to CFEH

Refraction and VA

Is the patient currently under ophthalmological care?

If yes, complete below:

Please select

Referring practitioner details

(to CC if locum unable to provide follow up on the report)

Clear Signature Pad