Referrers

Referring patients to Coastal Eye Surgeons

Patient referrals can be submitted via the form below, Healthlink, Oculo or fax.

Online Referral

Fill the online form below to refer your patient via our website. A copy of this form will be sent to our practice, as well as the email address you specify.

Our team will be in contact with the patient within 2-3 days of receiving the referral. For urgent cases, please contact us by phone on 07 5616 6008.

Printed Referral

Click on the link to download a PDF copy of our referral form. Referrals can be submitted by fax, healthlink, or Oculo. The original should be given to the patient.

Download referral form

Which doctor are you referring your patient to?(Required)

Patient Details

Patient Name(Required)

Title Given Name(s) Surname

Date of Birth(Required)

Phone Number(Required)

Referral Details

Date of Referral(Required)

Reason for Referral(Required)

Details

Referrer Information

Referred By:(Required)

Title Given Name (s) Surname

Provider Number(Required)

Practice Name

Practice Phone Number

Practice Email(Required)

A copy of this referral will be sent to this address.

Practice Address

Street Address Suburb State Post Code

Other Information

Drop files here or

Accepted file types: pdf, jpg, png, doc, docx, xls, xlsx, Max. file size: 1 MB, Max. files: 4.

Please upload any other relevant information to accompany this referral

Comments

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