For referring doctors

Resources for Referrers

In Baldwin Park and the San Gabriel Valley

Home  /  Referral forms

Refer a patient online in about a minute, with no download or fax needed. Prefer paper? Our fillable form is still available.

Refer a patient onlineCall (626) 960-3741
Man in glasses
For our colleagues in health care

Three easy ways to refer a patient

Ophthalmologists, optometrists, primary care, specialists, urgent care and other providers can choose whatever works best for their office. Our team contacts the patient to schedule and confirms with your office.

1Refer onlineFastest. Fill out a short form and attach the face sheet, notes, images or studies. No download, printing or fax.Start the online referral 2Fillable PDF formDownload our fillable form, complete it on your computer or print it, then fax it to (877) 991-4762.Download the PDF form 3Call us directlyPrefer to talk it through or need a same day visit? Call (626) 960-3741 and a real person on our team will help.Call (626) 960-3741

Refer a patient online

Required fields are the provider, patient name, date of birth and phone. Everything else is optional, so share whatever is helpful.

    Referring provider





    Patient





    Best time to reach the patient

    Urgency, eye and doctor

    Urgency

    Eye

    Our office will make every effort to honor your request.

    Reason for referral (check all that apply)

    Glaucoma

    Refractive

    Cornea and comprehensive

    Requested testing

    Clinical details: requested treatment and exam findings


    Attach face sheet, notes and studies

    Attaching the face sheet (demographics and insurance) speeds up scheduling. Add office notes, imaging, visual fields or other studies as needed. PDF, image or Word files, up to 10 MB each.




    Our team contacts the patient to schedule and confirms with your office. For urgent problems, please also call (626) 960-3741. You can still fax referrals to (877) 991-4762.

    Contact Us

    Find Us

    3000 Big Dalton Ave, Baldwin Park, CA 91706. Get directions

    Start seeing better today

    Let’s take care of your eyes

    Call, text or request an appointment online. We verify your insurance before your visit.

    Request an appointmentCall (626) 960-3741

    3000 Big Dalton Ave, Baldwin Park, CA 91706  ยท  Monday to Friday, 8am to 5pm, and some Saturdays