REFER A PATIENT


Thank you for referring your patient to the Queensland Eye Institute clinic.

To ensure the best care is provided for your patient, please complete the below online referral form and press "submit referral form" once finished or alternatively you can download our referral form and send it to us via fax on (07) 3844 2246 or email it to  
Once this is received we will be in touch with your patient to make arrangements for their appointment. 
Please note that all fields marked with a star (*) are mandatory.


*

Date of Referral

*

Referring to:

Dr Anthony Pane
Assoc. Professor Tony Kwan
Professor Ravi Thomas
Dr Brendan Cronin
Dr Mark Chiang
Dr Tai Smith
Dr Abhishek Sharma
unknown/unsure

Patient Details

*
*
*
*
*
*
*
*
if applicable/available
*
phone
email
Right Eye
Left Eye
Both
*

Referring Practitioner

*
*
*
*
*

*Security Check
Security Check
Enter the text in the image above.