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Referral Form - Milan Eye Center

Referral Form - Milan Eye Center 2025

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The document is a referral form for patients being referred to Dr. Milan R. Patel, a cataract, refractive, and corneal surgeon. It includes sections for the referring doctor's information, patient details, and the specific reason for the referral, such as cataract evaluation or LASIK evaluation. Additionally, it provides instructions for patients regarding necessary preparations for their appointment.

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Click ‘Get Form’ to open the Referral Form - Milan Eye Center in the editor.
Begin by entering the Referring Doctor's name and contact information, including phone and fax numbers, in the designated fields.
Next, fill in the Patient Name and Patient Phone Number to ensure accurate identification.
Select the reason for referral by checking the appropriate box for evaluations such as Cataract, Diabetic/Hyppertension, Glaucoma, or others listed.
If there are any special tests requested or additional notes, provide that information in the specified section.
Review all entered information for accuracy before saving or sending the form. Ensure that patients are aware of what to bring to their appointment.

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