Atlanta Eye Group
Located Inside LensCrafters ©
(772) 272-9470
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    Referrals

    DATE OF REFERRAL:
    REFERRING DOCTOR:
    NAME OF PRACTICE:
    OFFICE PHONE:
    OFFICE FAX:
    PATIENT NAME:
    PATIENT DOB:
    PATIENT PHONE:
    IS BEING REFERRED TO ATLANTA EYE GROUP FOR EVALUATION AND/OR MANAGEMENT OF:
    SUMMARY OF EYE FINDINGS:
    SPECIAL TESTS REQUESTED:

    • PLEASE VISIT OUR WEBSITE AT atlantaeyegroup.com TO COMPLETE YOUR NEW PATIENT PAPERWORK AND HAVE IT COMPLETED PRIOR TO YOUR VISIT.

    • IT IS THE PATIENT’S RESPONSIBILITY TO VERIFY INSURANCE PRIOR TO THE DAY OF THE APPOINTMENT.

    • PLEASE BRING YOUR INSURANCE INFORMATION WITH YOU TO THE APPOINTMENT.

    • PLEASE BRING A PAIR OF YOUR GLASSES WITH YOU TO THE EXAM.

    • PLEASE ARRIVE AT LEAST 10 MINUTES BEFORE YOUR SCHEDULED EXAM TIME
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