Thank you for entrusting us with the care of your patients. Please include any relevant history, photographs, or lab results as an attachment to this form. A printable version of this form is available here and can be faxed to 615-690-9398.
If faxing, no cover sheet is necessary and we ask that information sent be relevant only to the eyes. Thank you!
If this is an emergency, please call us at (615) 690-9399 for a consultation. We are not an emergency facility and are not set up to accept walk-ins. Otherwise, please have the client contact our office to schedule their appointment.