Patient Referral Process

Download our New Patient Appointment form and fax the completed document(s) to our scheduling department at 1-866-843-7990.  We will then contact your patient promptly, or your office if requested, to finalize the patient’s appointment.

Our scheduling department is available Monday-Friday, 8:00am to 5:00pm.

In addition to the patient’s demographics, our staff will request the following information:

  • Desired appointment time, date, and location
  • If you prefer the patient to be seen by a specific RNW physician
  • The patient’s complete current insurance information, including a copy of all cards
  • Diagnosis
  • Chart notes
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Patient Referral for Diagnostic Testing

Complete and fax the following Diagnostic Orders and Scheduling Worksheet form along with your orders, diagnosis, insurance information and applicable chart notes to 1-866-843-7990.

Physicians may refer their patients to Retina Northwest for the following diagnostic procedures, with interpretation:

  • Color Fundus Photography
  • Fluorescein Angiography **
  • Indocyanine Green (ICG) Angiography **
  • Spectral-domain OCT
  • Retinal Ultrasound

**Angiography interpretation is optional and is provided upon request.

For maps, directions, and contact information, please direct all newly-referred patients to the Contact Us section of this site.

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