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, NY 11801

Phone
(516)-939-6100

FAX
(516)-939-2510

Suffolk County Office
1455 Veterans Memorial Highway
Hauppauge, NY 11788

Phone
631-273-1818

Fax
516-939-2510