Vitreoretinal and Laser Surgery, Pharmacologic Retinal Treatment
Referral Form
Please complete this form, print and fax it to 516-939-2510. Due to HIPAA regulations we are unable to take referrals online or via e-mail at this time.
Nassau County Office 400 S. Oyster Bay Road Hicksville, NY11801
Phone (516)-939-6100
FAX (516)-939-2510
Suffolk County Office 1455 Veterans Memorial Highway
Hauppauge, NY 11788