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Provider Relations

Refer a patient

Thank you for entrusting us with the care of your patient. We promise to uphold the highest standard of individual care for each patient.

Fax completed referral forms to 715.870.2401 or 715.803.2856.

For questions regarding a patient referral status, contact our Referral Coordinators at 715.261.8548.

Records Request

Fax records requests to 715.261.8665.

Glasses and contact lenses prescription request

Please call 715.261.8500 or fax your request to 715.261.8665 for glasses and contact lenses prescriptions.

Referral Forms:

Cataract Referral Form

General Referral Form

Low Vision Referral Form

Post-Cataract Assessment

Glaucoma Data Sheet

Refractive Surgery Referral Form

Eye Clinic of Wisconsin complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Eye Clinic of Wisconsin does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Eye Clinic of Wisconsin provides free aids and services to people with disabilities to communicate effectively with us, such as; qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic formats, other formats), and free language services to people whose primary language is not English.