ConnectedCare | Refer a Patient

If your patient has an open referral / is being referred today to HES / GP, please wait until referral has been concluded.

Active eye / health queries or issues need to be resolved or managed to a stable status prior to referral to Optegra.

Referrer Name(Required)

Referrer Email(Required)

Practice Name(Required)

ODS Code(Required)

Practice Phone Number(Required)

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ADM Email

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Patient Name(Required)

Patient DOB(Required)

Patient Address lookup(Required)

Search by postcode or house number and street

Patient Address(Required)

Street Address City Post Code

Patient Phone Number(Required)

Patient Email(Required)

Patient’s Prescription

Eye

UDVA

Sph

Cyl

Axis

BCVDA

UNVA (40cm)

Add

BCNVA

UCDV(Required)

SPH(Required)

CYL(Required)

AXIS(Required)

Prism

BCDVA(Required)

UCNV (40cm)(Required)

Add

BCNVA(Required)

UCDV(Required)

SPH(Required)

CYL(Required)

AXIS(Required)

Prism

BCDVA(Required)

UCNV (40cm)(Required)

Add

BCNVA(Required)

Additional Relevant Information

File Upload

Please upload any file (e.g. image or document) that you think would be helpful to us and provide additional information.

Drop files here or

Max. file size: 128 MB.

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Consent*

I confirm(Required)

I have referred my patient to Optegra for expert independent advise and further discussion on vision correction treatment / private cataract surgery.

I confirm(Required)

I understand that initial consultation and scans are complimentary. *For complex case scenarios deemed by Optegra, a consultant-fee will be applicable, this will be discussed with the patient.

I confirm(Required)

I’m happy for patient to be referred back to me if deemed unsuitable / patient opts not to proceed with surgery / routine sight tests post-surgery discharge.

I confirm(Required)

I have consent to share my patients’ contact details for the purpose of booking a consultation with Optegra.