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.

* Required Patient Information: First Name:

Last Name:

Email:

Phone:

Insurance Carrier:

Referrer's Information: Doctor's Name:

Phone:

Comments:

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“I enjoyed working with each member of your team. The receptionists were friendly and polite, and Tamara was quite knowledgeable and did a great job putting me at ease! You and your surgical team were patient and kind. For these things and more, I say thank you!” Joy K. Hughley - Orlando, FL