Please fill out the referral form below to refer your patient/s

or you can download a Request Form and email to

If your patient is required to see one of our ophthalmologists urgently (within 1-2 days), please call the clinic directly on (03) 9417 1011.


For after hours care, please direct the patient to the Royal Victorian Eye and Ear hospital (RVEEH).


Patient's Details

Reason for Referral / Relevant History 

Referring Practitioner