Physician Referral Forms

Select the office you wish to refer your patient. The printable referral form will automatically begin to download. Please fax the completed form to the phone number at the bottom of the document.
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What our Patients are Saying

Our Success Story

"Had a pleasant experience there. Retina surgery & excellent follow up. Results as expected. "Thank you" to the whole staff,
& especially my surgeon."
~ Sue Uhlar Patella, April 2017

"First time for me at the Canton Office. The entire staff was welcoming and kind. They all knew I was nervous, I guess the deer in the headlights look on my face tipped them off. Dr. Conti is always saying, "you are doing great". Whole experience wasn't as bad as I thought." 
~ Kimberly Wilson, November 2016

"Office runs very effectively. Employees and doctors are very pleasant and knowledgeable. They are VERY busy. I literally trust them with my sight!"
~ Kathy DiAntonio, July 2015

"Thank you for helping my infected eye go from barely able to see the big E to 20/20 in less than two weeks. I am grateful." 
~ Herb Riede, July 2016