---
title: Optometrist to Ophthalmologist Referral Form Template | Paperform
description: Professional referral form for optometrists to refer patients to ophthalmologists with vision tests, eye pressure readings, suspected diagnosis, and urgency classification.
url: "https://paperform.co/templates/optometrist-to-ophthalmologist-referral-form"
type: static
generatedAt: "2026-03-28T00:44:41.477Z"
---

[← Back to free form templates](/templates/)    ![Optometrist to Ophthalmologist Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/optometrist-to-ophthalmologist-referral-form.png)
    [Preview](https://_preview.paperform.co/ai-template/optometrist-to-ophthalmologist-referral-form) [Use this template for free](/create?ai-template=optometrist-to-ophthalmologist-referral-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Industry-Specific Forms](/templates/category/industry-specific/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Optometrist](/templates/role/optometrist/)     About this free form template
### Streamline Eye Care Referrals with Paperform

When your patients need specialized ophthalmologic care, clear communication between providers is essential. This **optometrist to ophthalmologist referral form** template helps eye care professionals document comprehensive patient information, test results, and clinical findings in one organized submission.

Whether you're referring patients for cataract evaluation, glaucoma management, retinal conditions, or urgent eye emergencies, this form captures all the critical information ophthalmologists need to prioritize appointments and prepare for consultations.

#### Designed for Optometry Practices and Eye Care Clinics

This template is built specifically for optometrists, optometric physicians, and eye care clinics who regularly coordinate specialist referrals. The form includes structured fields for:

 - Complete patient demographics and insurance information
 - Detailed vision assessment results (visual acuity, refraction, and more)
 - Intraocular pressure readings and testing methods
 - Suspected diagnoses and clinical observations
 - Urgency classification to help ophthalmologists triage appropriately
 - Supporting documentation upload for fundus photos, OCT scans, and visual field tests

By digitizing your referral process with Paperform, you eliminate illegible handwriting, lost fax pages, and incomplete information that can delay patient care. The conditional logic ensures you capture relevant details based on the referral reason, while the professional layout maintains the clinical credibility your practice is known for.

#### Automate Your Referral Workflow with Stepper

Once a referral is submitted, you can use [Stepper](https://stepper.io) to automatically route the information to the appropriate ophthalmology practice, send confirmation emails to patients with next steps, update your practice management system, and even trigger follow-up reminders. This ensures no referral falls through the cracks and patients receive timely specialist care.

Paperform's GDPR and SOC 2 Type II compliance means sensitive patient health information is handled securely, while integrations with healthcare tools keep your existing workflows intact. Whether you're a solo practitioner or part of a multi-location optometry group, this template adapts to your referral volume and coordination needs.
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