header shadow image For Professionals section image For Professionals  section image

Make a Referral

Fill out the form below, or download it here. (Referral Service Form)

Yes    No

Important: Please send a copy of the most recent eye exam along with this form.

I would like my patient to continue care at SUNY for the referred issue. Patient is to return to me for comprehensive care.

I would like to transfer care of this patient to SUNY.

Referred to (check one) *

Imaging Center Only (Diagnosis Needed)    Consultation   
Consultation & Treatment

If Imagining Center Only (check one)

With Interpretation    Without Interpretation   

Is This Referral Urgent?*

Yes    No

Special Testing

Specialty Care