Patient Referral Process

Either fill out the online patient referral form or fax or email in the PDF fax referral form.

Our online form makes it easy to submit patient information and allows us to receive your request as quickly as possible. If you’d prefer to fill out a paper form and fax or email it in, click the ‘Fax Referral Form’ link below, then please fax forms and patient information to (719) 227-0669.

Provide required patient information whether submitting online or via fax/email.

We request the following information to be submitted with all referrals:

Patient Information & Demographics

Medical Information

Referring Physician Information

Scheduling Information

Exam Notes

Insurance Information

If you have an emergent referral and would like for your patient to be seen as soon as possible, please call us directly at (719) 473-9595 ext. 0.

Refer A Patient Online

Fax Referral Form

What to Expect After Submitting a Referral to RCSC

Thank you for trusting us to provide the best possible care for your patients. We do our very best to accommodate your scheduling needs and that of your patients.

We will confirm receipt of your referral via email. Most referrals will be processed in 2-3 business days. Should you want your patient seen urgently, please call us directly at 719-473-9595 ext. 0.
We will contact your patient for an appointment at an appropriate time. Your patient will be scheduled in a timely manner based on the nature of the disease.
You will receive notifications regarding your patient’s appointment date and time.
After your patient has been seen, you will receive a written letter detailing the appointment.

We’re Standing By!

Submit a Referral Now

Refer A Patient

Patient Referral Process

Either fill out the online patient referral form or fax or email in the PDF fax referral form.

Provide required patient information whether submitting online or via fax/email.

What to Expect After Submitting a Referral to RCSC

We’re Standing By!

Submit a Referral Now

RETINA CONSULTANTS

OF SOUTHERN COLORADO

FOR PHYSICIANS

FOR PATIENTS

POLICIES