Provider Referral

Refer a Patient

Today's Date
MM slash DD slash YYYY
Doctor's Name*
First Last
Doctor's Phone
Doctor's Email*
Doctor's Address
Street Address Address Line 2 City State Zip Code
Preferred Method of Communication
- Email
- Fax
- Phone
Patient Name*
First Last
Patient Phone*
Patient Date of Birth
MM slash DD slash YYYY
Please indicate the type of visit in the checkboxes below.
Reason for Referral
Treatment plan*
- One-Time Consult
- Diagnose and Treat this Problem
- Co-Manage
- Follow Patient Along With Me
- Transfer Complete Management
- I Will Follow for Routine Care Only
Notes:

Hours

Williamsville:
MON — FRI
8:30 AM to 5:00 PM

SAT — SUN
Closed

Orchard Park:
MON — THU
7:30 AM to 4:00 PM

FRI
7:30 AM to 1:00 PM

SAT — SUN
Closed

Contact Us by Phone

Williamsville:
(716) 706-4945

Orchard Park:
(716) 706-4998

Expert Care from Your Buffalo Ophthalmology Specialists

At Buffalo Ophthalmology, our experienced specialists are here to take care of your needs with expertise, compassion, and comfort. When you trust us with your eyes, you can rest assured that you’re getting the best care in Buffalo.

Provider Referral

Refer a Patient

Hours

Contact Us by Phone

Expert Care from Your Buffalo Ophthalmology Specialists

Buffalo Ophthalmology - Northtowns

Buffalo Ophthalmology - Southtowns

Buffalo Optique (Southtowns)