Refer a Patient

Referrers

If your patient needs to be seen within 24 hours please call our team on 1800 111 374.

Please complete the online referral form below or download a PDF copy.

Patient Referral Form

Patient Title

Patient First Name *

Patient Surname *

Patient Date of Birth (DD/MM/YYYY)

Patient Address

Patient Phone *

Patient Email *

Preferred Specialist

Preferred Clinic

Eye Condition

Reason for Referral *

Optometric Details: Refraction

Referrer Name *

Provider No *

Practice Name / Address *

Practice Phone *

Signed by (your name) *

Date *

File Upload: Further Patient Information

Maximum file size: 104.86MB

reCAPTCHA

If you are human, leave this field blank.

Our Specialists

Dr Robert Bourke

Dr Lewis Lam

Dr Sharon Morris

Dr Daniel Allbon

Dr Darryl Gregor

MEET OUR TEAM

Southport

1800 111 374

Ground Floor, 2 Short Street, Southport, QLD 4215

Mon

8:00am to 4:30pm

Tue

8:00am to 4:30pm

Wed

8:00am to 4:30pm

Thu

8:00am to 4:30pm

Fri

8:00am to 4:30pm

Sat

Closed

Sun

Closed

Request Appointment

Varsity Lakes

1800 111 374

Level 2, Bermuda Point, 1 Lake Orr Drive, Varsity Lakes QLD 4227

Mon

8:00am to 4:30pm

Tue

8:00am to 4:30pm

Wed

8:00am to 4:30pm

Thu

8:00am to 4:30pm

Fri

8:00am to 4:30pm

Sat

Closed

Sun

Closed

Request Appointment

Coolangatta

1800 111 374

Level 2, The Strand, 72-80 Marine Parade Coolangatta QLD 4225

Mon

8:00am to 4:30pm

Tue

8:00am to 4:30pm

Wed

8:00am to 4:30pm

Thu

8:00am to 4:30pm

Fri

8:00am to 4:30pm

Sat

Closed

Sun

Closed

Request Appointment