Doctor Patient Referrals

We’re committed to making patient referrals as seamless as possible for our partnering providers. This page allows you to submit referrals quickly and securely through our online form. Once received, our team will follow up promptly to coordinate the next steps in your patient’s care.

Dr. Lee with a fellow doctor and a patient

Home | Doctor Patient Referrals

Click Here to Download Our Patient Referral Form

Refer a Patient

If you are interested in referring a patient, please fill out the form below and a member of our team will get in touch. Note: Please do NOT include any sensitive patient information in your submission.

Referral Form

Referring Doctor Name

Referring Doctor Practice Name

Referring Doctor Email

Referring Doctor Phone Number

Comments

Terms

I accept the Terms of Use

*By submitting this form you consent to receive phone calls, text messages and emails from California Center for Refractive Surgery. It is not a condition of purchasing any goods or services. You can opt out at any time, message/data rates may apply, and opting-in includes acceptance of the Privacy Policy and Terms of Use. Communications through this website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

If you have any other inquiries or requests, please call us or email us at: contact@ccrsvision.com

If you are human, leave this field blank.