Referring Provider

Dear Referring Provider,

Family Eye wellness strives to make it easy and hassle-free to refer patients. You can use the online referral intake form below to make referrals.

We take referrals for:

  • Functional/binocular vision evaluations
  • Visual perceptual testing
  • Pediatric and infant eye examinations
  • Special needs eye examinations
  • Myopia control management
  • Comprehensive eye exams for patients of all ages


Please click here to view the symptom checklist. You may print it out and use it as needed to determine whether or not a patient needs a functional or perceptual vision evaluation.

When you refer a patient to Family Eye Wellness, we will send you a report to assure continuity of care. We look forward to collaborating with you in the continued care of our mutual patient’s vision care needs.
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Will you be faxing further information to us?*
Please fax all pertinent exam records to 984 263-2914
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