Medical professionals, such as the doctor in this photo, can make Eye Care Professional Referrals to SDCB

Eye Care Professional Referrals

For Medical and other Health Care Professionals

When medical approaches and prescriptive eyewear can longer assist your patients to reach their vision goals, SDCB is here to provide the much needed services to help them to become as independent as possible.

If you are a medical professional looking for additional options for your patients, please contact us.


How to contact SDCB to make a referral

You have three options:
  1. Complete the form below. Be sure to print a copy for your patient.
  2. Contact us in San Diego (1.619.583.1542) or in Vista (1.760.758.5956).
  3. Contact us at referral@sdcb.org.

Please enter the information for the doctor or
health care professional making the referral 
Salutation *
First Name *
Middle Name
Last Name *
Title
Company or Profession
Group/Affiliation Name
Email
Fax
Phone *
Address *
City *
State *
Zip *


Please enter information for the patient/client being referred
OK for SDCB to directly contact?
List Services Needed
Patient's First Name *
Patient's Middle Name
Patient's Last Name *
Phone Number *
E-mail Address
Street Address *
City *
State *
Zip Code *
Date of Birth *
Choose Date
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Contact phone 2
Corrected Distance Acuity OD *
Corrected Distance Acuity OS *
Current distance prescription OD
Current distance prescription OS
Near Add
Diagnosis *
ICD-10 Code
Date of last exam *
Choose Date
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ocular history/add'l info

Cause of Vision Loss

Please provide the following if possible.
Major Cause of Vision Loss
OD Acuity
OS Acuity
Other Information

Thank you for the referral.
Please also fax the most recent examination note
and visual field report, if available, to 619.286.3038

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