OPTOMETRIST REFERRAL FORM

Patient contact details

Assistance required

Patients preferred location

Unfortunately COVID-19 has affected our ability to operate our Sutherland clinic and it is currently closed until further notice.

The UNSW and Cameron Centre (Parramatta) clinics are now open for referrals as per usual.

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