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 copy here. To help your patients find us, please print a directional map for the desired location Southport , Varsity Lakes, or Coolangatta.

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

reCAPTCHA

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