Referrals

Quickfire Referral

considerations? Email Phone

Practice Name

Thank you for working with us! We truly value your partnership!

Practice Email

We will send a confirmation email to the practice. (Check your Spam if you cannot find it in your Inbox).

Referring Doctor:

Date:

Patient Name

First

Last

Patient Phone Number

Patient Age

Birth Date

Recommended surgery

Premium Cataract
RLE
ICL
IOL Upgrade / Exchange

Patient Email

Other considerations?

Thank you for your referral! Please let us know your other thoughts, for example: ocular diagnoses, and patient preferences.
The lead time to surgery is usually less than 2 weeks.
As a reminder, we do not accept insurance but in lieu of this, we can provide the patient with reimbursement codes to obtain coverage for their procedures as well as other financial assistance.

Save and Resume Later

You can find us at

EMAIL (PHI Compliant)

referral@nearandfarvision.com

PHONE NUMBER

425-900-2414

FAX NUMBER

425-332-5141

LOCATION

Near and Far Vision Partners,
19909 120th Ave NE STE 202, Bothell WA 98011

We will contact your patient and send a confirmation to you within 1-2 business days.

Thank you for your trust and partnership!