We encourage all practices to call 785-841-2280 to refer a patient to us, this ensures that the most appropriate appointment type is selected on behalf of the patient. In the case of non-emergent patients, however, you may fill out the form that follows these instructions. It is our goal to see all referred patients within 2-4 weeks, if you feel it should be sooner please call.

*IMPORTANT* We are NOT contracted with Medicaid, Allwell or Ambetter. If you have a patient with one of these we would be glad to see them; however they MUST be made aware that it will be a self-pay appointment.

*IMPORTANT* When filling out the referral form below, please reiterate to the patient the importance of being available by phone and/or to monitor their voicemail. Our office will attempt to contact the patient no more than twice after a referral is received. If a referred patient no-shows for an appointment a letter will be sent back to the referring physician’s office.

For emergency patients a phone call is required so that we may take care of your patient quickly.

PATIENT INFORMATION NEEDED WHEN CALLING:

  • Name

  • Mailing address

  • Primary phone number

  • Date of birth

  • Type of insurance, Member ID, primary holder name and DOB

  • Nature of medical issue (cataract consultation, yag laser, chalazion, etc)

  • Urgency of the issue (need same day appointment, first available, etc)

WE ALSO NEED TO KNOW:

  • Referring physician’s name

  • Referring physician’s clinic notes

Referral Request Form

Please fill out all required fields and we will be happy to schedule your patient for an appointment right away!