Eye Doctor’s Patient Referral Form

As one of the leading LASIK surgeons in the country, Dr. Brock Magruder, Jr., specializes in refractive laser eye surgery procedures including ICL, PRK, RLE, LASIK and Cataract eye surgery, and we welcome medical referrals. As a physician, we understand your time is valuable, so we make it as easy and quick as possible to refer your patients to our practice. Simply fill out the form below to begin the referral process.

You and your patients’ privacy are extremely important to us. We will never share, trade or sell your information, and this information is transmitted via a secure connection.

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Patient Referral Form

Tell us about your patient's needs.

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Patient Information:

Referrer's Information:

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We will never sell, share, or trade the information you provide with a third party