Refer a Patient

Westmead Eyes welcomes referrals from optometrists, ophthalmologists, general practitioners and allied health professionals.

Please complete the referral form below and include any relevant clinical information. Our team will contact the patient to arrange an appointment.

Urgent or time-sensitive referral?
Please submit the form and call (02) 9635 8464 so our team can assist promptly.

Referring Practitioner Name *

First

Last

Provider Number *

Referring Practice Name *

Practice Phone *

Practice Email *

Practice Fax

Patient Name *

First

Last

Patient Date of Birth *

Patient Phone *

Patient Email

Referral For *

Reason for Referral/ Clinical Information

Patient-consent confirmation

I confirm that the patient has consented to Westmead Eyes receiving their personal and clinical information and contacting them regarding this referral.

Footer