Get the free OPTOMETRIC VISION THERAPY REFERRAL FORM

OPTOMETRY VISION THERAPY REFERRAL FORM REFERRAL TO: Alderwood Vision Therapy Center, LLC 16006 Ash Way, Suite 101 Lynnwood, WA 98087 Phone: (425) 7875200 Fax: (425) 7875252 www.alderwoodvisiontherapy.com

How to fill out optometric vision formrapy referral

How to Fill Out Optometric Vision Therapy Referral:

1. Begin by gathering all relevant information about the patient, including their personal details, medical history, and any previous vision therapy treatments.
2. Fill out the referral form accurately, ensuring that all sections are completed with the necessary information. This may include the patient's name, age, contact information, and insurance details.
3. Provide a detailed description of the patient's visual concerns or symptoms that indicate the need for optometric vision therapy. This could include difficulties with reading, tracking, depth perception, or any other visual challenges.
4. Include any additional information about the patient's overall health that may be relevant to their vision concerns. This may involve past medical conditions, current medications, or other factors that could impact their vision therapy treatment.
5. Clearly indicate the reason for referral to optometric vision therapy. This could be based on the findings from a comprehensive eye examination or the recommendation of another healthcare professional.
6. If available, attach copies of pertinent medical records, diagnostic test results, or previous vision therapy reports that support the need for optometric vision therapy referral.
7. Ensure that the referral form is signed and dated by the referring healthcare professional, and that their contact information is provided.
8. Make a copy of the completed referral form for your records before sending it to the appropriate optometric vision therapy provider.

Who Needs Optometric Vision Therapy Referral:

1. Individuals who have experienced visual difficulties or symptoms that have not been effectively addressed with traditional eyeglasses or contact lenses.
2. Patients who have been diagnosed with specific visual conditions that require specialized vision training, such as strabismus, amblyopia, or binocular vision disorders.
3. Individuals who have been referred by other healthcare professionals, such as pediatricians, optometrists, or ophthalmologists, who believe that optometric vision therapy could be beneficial for their patients' visual concerns.
4. People seeking to enhance their visual performance and improve skills related to reading, sports, or other activities that require optimal visual processing.

In summary, filling out an optometric vision therapy referral involves accurately completing the necessary sections of the form, providing detailed information about the patient's visual concerns, and attaching any relevant medical records. Optometric vision therapy referral may be needed for individuals with unresolved visual difficulties, diagnosed visual conditions, or recommendations from other healthcare professionals.

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What is optometric vision formrapy referral?

Optometric vision formrapy referral is a process where a patient is referred to a specialized eye care provider for further evaluation and treatment.

Who is required to file optometric vision formrapy referral?

Optometrists, ophthalmologists, or other eye care professionals are required to file optometric vision formrapy referrals.

How to fill out optometric vision formrapy referral?

To fill out optometric vision formrapy referral, the eye care provider must include the patient's information, reason for referral, and any relevant medical history.

What is the purpose of optometric vision formrapy referral?

The purpose of optometric vision formrapy referral is to ensure that patients receive appropriate and timely care for their eye conditions.

What information must be reported on optometric vision formrapy referral?

Information such as patient's name, contact information, reason for referral, medical history, and referring eye care provider's information must be reported on optometric vision formrapy referral.

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