Please email the information below to info@spanishoakseyecare.com with subject “Referral”
1- Name of referring provider & practice name
2- Practice phone #
3- Practice fax #
4- Please indicate if the provider would like to co-manage the patient or not. Or if they want to discuss with prior to deciding.
5- Patient first and last name
5- Parent or guardian first and last name and their relationship to the patient.
6- Date of Birth of patient
7- Patient phone #
8- Patient email address
9- Last 2 Rx’s with dates if available
10- Any other information you would like to provide
Thank you for your referral,
Dr. Dina Miller, OD, IACMM