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. Alternatively, you can download a PDF copy here and we also accept referrals via email, fax or Oculo.

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 upload size: 2.1MB

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Our Specialists

Dr Robert Bourke

Dr Lewis Lam

Dr Sharon Morris

Dr Darryl Gregor

Meet our Specialists

Southport

1800 111 374

Ground Floor, 2 Short Street, Southport, QLD 4215

Mon

8:00am to 5:00pm

Tue

8:00am to 5:00pm

Wed

8:00am to 5:00pm

Thu

8:00am to 5:00pm

Fri

8:00am to 5:00pm

Sat

Closed

Sun

Closed

After-hours and weekend appointments are available for emergencies.

Call us on 1800 RETINA (1800 738 462). Fees and charges apply. Medicare rebates available with a referral from your Optometrist or GP.

Request Appointment

Varsity Lakes

1800 111 374

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

Mon

8:00am to 5:00pm

Tue

8:00am to 5:00pm

Wed

8:00am to 5:00pm

Thu

8:00am to 5:00pm

Fri

8:00am to 5:00pm

Sat

Closed

Sun

Closed

After-hours and weekend appointments are available for emergencies.

Call us on 1800 RETINA (1800 738 462). Fees and charges apply. Medicare rebates available with a referral from your Optometrist or GP.

Request Appointment

Coolangatta

1800 111 374

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

Mon

8:00am to 5:00pm

Tue

8:00am to 5:00pm

Wed

8:00am to 5:00pm

Thu

8:00am to 5:00pm

Fri

8:00am to 5:00pm

Sat

Closed

Sun

Closed

After-hours and weekend appointments are available for emergencies.

Call us on 1800 RETINA (1800 738 462). Fees and charges apply. Medicare rebates available with a referral from your Optometrist or GP.

Request Appointment