Referrals

Thank you for choosing to refer to Athens Retina Center.  Our referrals are our partners and our customers.  We are available to you and your patients to deliver the care needed. Our state-of-the-art clinic has been designed to deliver patient-focused services.

You can complete the referral form as a PDF and fax it to our office at 706-433-1745 or call our office at 706-543-3200 and press option 5.


Begin a referral with the form below: 

"*" indicates required fields

Patient Demographics

Name*
Date of Birth*
Address*

Referring Doctor Information

Patients Current Vision*
OD
OS
 
Please attach any office or patient notes along with copies of the patient's insurance card (front and back)
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 50 MB.
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    For Office Use Only

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    Notes Recieved from Referring
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    Appointment Scheduled with
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    Informed Referring About Appointment By
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    On what date
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    at what time
    :
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    Appointment Date
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    Appointment Time
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    This field is for validation purposes and should be left unchanged.

    You can also complete the referral form as a PDF and fax it to our office at 706-433-1745 or call our office at 706-543-3200 and press option 5.


    When contacting us to schedule your patients, please have the following information readily available:

    • Patient demographic information
    • Reason for visit
    • Any special needs that will require facilitation once the patient arrives
    • Patient insurance information, if available

    We will work with your patient to complete the registration process and to schedule an appointment at the patient’s convenience.

    What Our Patients Say

    Your calm during my storm made all the difference in the world. Thank you for that.