Referring Providers

Patient Referral

Thank you for referring your patients to the Retina Center of Texas.

To refer your patient for vitreoretinal consultations, diagnostic tests, evaluations, and procedures, please complete and submit this form.

Submit Referral Form

We are dedicated to the highest standards of vitreoretinal treatments for your patients and unsurpassed service to the needs of our referring physicians. The Retina Center of Texas is equipped with the latest state-of-the-art equipment to ensure our commitment to delivering the best possible care for your patients.

We know you have a choice in whom you send your patients, and we appreciate your trust in our team. We are also committed to providing you with prompt and accurate communication about your patient. Our physicians are available to see new patients every day in the clinic. Urgent or emergent referrals will be seen on the same day. Access to a consultant is available 24 hours a day, 7 days a week, 365 days a year.

For more information or if this referral is urgent, please call our main number at (817) 865-6800.

Printable Version

If you prefer to use a paper referral form, please download this PDF version and return the completed file via email to or fax to (817) 865-6790.

Download PDF