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Cataracts
What are cataracts
About your consultation
Cataract surgery
Lens options
Cataract surgery aftercare
Posterior capsule opacification
RLE
What is RLE
RLE surgery
About your RLE consultation
RLE Aftercare
RLE-lens options
Why choose
Meet our team
Blog
Treatments
Implantable lens surgery
Glaucoma
Keratoconus
Lacrimal disorders
Macular degeneration
Oculoplastics
YAG laser
Sight sim
Pricing
Clinics
Contact us
Login
Cataracts
What are cataracts
About your consultation
Cataract surgery
Lens options
Cataract surgery aftercare
Posterior capsule opacification
RLE
What is RLE
RLE surgery
About your RLE consultation
RLE Aftercare
RLE-lens options
Why choose
Meet our team
Blog
Treatments
Implantable lens surgery
Glaucoma
Keratoconus
Lacrimal disorders
Macular degeneration
Oculoplastics
YAG laser
Sight sim
Pricing
Clinics
Contact us
Login
Menu
Cataracts
What are cataracts
About your consultation
Cataract surgery
Lens options
Cataract surgery aftercare
Posterior capsule opacification
RLE
What is RLE
RLE surgery
About your RLE consultation
RLE Aftercare
RLE-lens options
Why choose
Meet our team
Blog
Treatments
Implantable lens surgery
Glaucoma
Keratoconus
Lacrimal disorders
Macular degeneration
Oculoplastics
YAG laser
Sight sim
Pricing
Clinics
Contact us
Login
Optometrist Referral Form
*This form will only submit once all fields are complete
Priority:
*
Urgent
Routine
Referral to:
*
Next available
Jonathan Ross
Sanjay Mantry
Practice name:
*
Referring optometrist/optician:
*
Referrer Email:
*
Optometrist Address
*
Street Address
Address Line 2
City
Post code
Patient details
Patient ID:
Patient name:
*
First
Last
Date of birth:
*
Patient phone number:
*
Patient Address
*
Street Address
Address Line 2
City
Post code
Other:
Reason for referral:
*
AMD
Cataract
Eye lid
Glaucoma
Keratoconus
Laser (lasek / lasik)
Refractive lens exchange
YAG laser
Watery eye
Other
Cataract referrals:
*
Standard lens implant
Premium lens option if suitable
Right eye
Va unaided:
VA corrected:
sphere:
cyl:
Axis:
Near un:
Near Corr:
Left eye
Va unaided:
VA corrected:
sphere:
cyl:
Axis:
Near un:
Near Corr:
Please summarise your referral:
Permission check:
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I have the patients permission to retain their medical information and share it with Laser Vision Scotland for clinical purposes. The patient will not be contacted for any other purpose.
Optometrist GDPR:
*
I agree to the GDPR data sharing agreement between optometrist and Laser Vision Scotland
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