Skip to main content

Dear Valued Patient,

At Eyeland Vision, the health and safety of our patients and employees is our top concern. We care about the health and well-being of our patients and staff.

As a precautionary measure, we are temporarily closing our office for further notice. We are hoping this will end soon, but please check back to our website for continued updated.

At this time we are accepting only medical emergencies, please call or text our office for further assistance.

For orders such as contacts and glasses, these items will be shipped to patients home if home address has been verified. Please leave us a voicemail or text for any further questions.

We apologize for the inconvenience. Thank you.

Click here for more details.

Book Exam
Map
Call Us
Menu
grafitti-brick-wall-overlay-purple
Home » Referral Request form – Dry eye treatment

Referral Request form – Dry eye treatment

Referral Request form - Dry eye treatment

  • Date Format: MM slash DD slash YYYY
  • The above mentioned patient has presented the following condition(s);

    • H40.013; Dry eye syndrome of bilateral lacrimal glands
    • H16.223; Keratoconjunctivitis sicca, not specified as Sjogren's, bilateral

    Requesting referral for additional testing due to medical findings that require further treatment. Below is a list of procedures that will need to be performed.

    • 68761 Punctal plugs
    • 83516 InflammaDry
    • 83861 TearLab Osmolarity Microfluidic Analysis Utilizing an Integrated
    • 65778 Prokera Graft

EyecareLive

Now Offering EyecareLive
You can now see us virtually through EyecareLive.

SET UP YOUR VIRTUAL CONSULTATION TODAY!

GET STARTED BY DOWNLOADING THE APP


apple app store
google play

Once you download the app follow the instructions by clicking below.

VIEW SCHEDULING PROCESS