Direct Referral Form for Cataract Surgery - loc-netorguk - loc-net org 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, GP's name, and optometrist's name in the designated fields. Ensure accuracy for proper identification.
3. Fill in the patient's date of birth and address details. This information is crucial for patient records.
4. Provide contact numbers and NHS number where indicated. This facilitates communication regarding the referral.
5. In the 'Reason for referral/Symptoms' section, clearly describe the patient's symptoms and any ocular co-morbidities.
6. Complete the visual acuity fields (R Sph., L Sph., etc.) with current prescription details to assist in assessing cataract severity.
7. Indicate if PCT referral thresholds are met by selecting appropriate options from the provided categories.
8. Fill out medical history as required, ensuring all relevant conditions are noted for comprehensive care.
9. Finally, ensure both optometrist and patient signatures are obtained before submitting the form. Print copies as needed for all parties involved.

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