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Uptown eye specialists referral form 2026

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The document is a consultation request form for an eye clinic located in Concord, Ontario. It includes sections for referring doctors and patient information, as well as details about various eye specialists available at the clinic. The form outlines the urgency of the referral and provides options for specific eye conditions such as cataracts, glaucoma, and pediatric issues. It emphasizes the importance of completing all information legibly to ensure processing.

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Click ‘Get Form’ to open the uptown eye specialists referral form in the editor.
Begin by filling in the 'Referring Doctor' section with your name, followed by your OHIP Billing number and office phone details. Ensure all information is legible.
Next, enter the patient's last and first name, date of birth (Y-M-D), and gender. This information is crucial for accurate patient identification.
Complete the health card number and version code fields to facilitate billing and insurance processing.
Indicate your urgency preference by selecting from options such as Routine, ASAP, or Urgent. You can also specify a special request if needed.
In the 'Reason for Referral' section, check or circle applicable conditions like Cataract or Glaucoma. Provide additional information in the remarks section if necessary.
Review all entries for accuracy before submitting. Incomplete forms will not be processed.

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Versions	Form popularity	Fillable & printable
2022	4.2 Satisfied (43 Votes)
2016	4.2 Satisfied (57 Votes)
2012	4 Satisfied (23 Votes)

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How do I email uptown eye specialists Brampton?

We aim to care for our patients compassionately in a technologically cutting edge environment using the latest advances in clinical research. For appointment inquiries, please email us: info@uptowneye.ca. Please note that during peak hours, emails typically receive a quicker response.

How do I email Optegra?

If you require support to complete, please contact our patient services team on 0800 086 1064 or email eyecare@optegra.com.

Who to contact for eye problems?

Ophthalmologists. Ophthalmologists (eye surgeons) are doctors that specialise in the medical and surgical care of the eyes and visual system. They also look into the prevention of eye disease and injury. An ophthalmologist treats people of all ages, from premature babies to the elderly.

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