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For Providers

Make A Referral

Community healthcare providers like you are essential to help the Illinois Eye Institute fulfill its mission. The IEI has world renowned optometrists and ophthalmologists in all areas of sub-specialty eye care including: glaucoma, pediatrics, retina/vitreous, cornea, cataract, anterior segment, neuro-ophthalmology and vision rehabilitation. IEI’s state-of-the-art diagnostic technologies are available to assist you in the diagnosis and management of your patients.

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Patient Info

Is this HMO?

Referral Info

Referring Patients for: (check all that apply):

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Glaucoma

Retina and Diabetes Eye Service

Cornea and Contact Lens Service

Dry Eye Service

Myopia Control

Keratoconus

Corneal Crosslinking

Cataract

Refractive Surgery Consult

Low Vision Rehabilitation

Pediatrics / Binocular Vision

Special Populations Service

Electrodiagnostic Service

Neuro-Ophthalmology

Other (please explain below)

Diagnostic Testing

Referring Patients for: (check all that apply):

OCT of anterior chamber angle

OCT of ONH

OCT of macula

OCT with Angioplex

Fundus Photos

Meibography

Topography / Tomography

A-Scan / IOL Master

B-Scan

Pachymetry

Visual Field Testing

Endothelial Cell Count

Completing this portion of the form will allow our consulting doctors to provide correspondence in a timely manner. 

Call my patient to make appointment

My patient will call to schedule appointment

Appointment Made for

at

:

We pledge to be compassionate, timely, and accessible to you and your patients.
We are committed to providing excellent and customized service to you and your staff.

  1. Our staff will inform you of your patient’s appointment date and time.

  2. Upon completion of the service request, a comprehensive report with all appropriate test results will be sent to your office.

  3. You will have the opportunity to co-manage your patient.

  4. You will be informed of all treatment decisions and outcomes.

Thank you for choosing and trusting the Illinois Eye Institute. We look forward to sharing in the care of your patients.

SUBMIT REFERRAL
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