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

"Thorough exam and explanation of findings. Office is run very efficiently."
March 2022

"Everything about my status and treatment is explained thoroughly and options are offered along with his recommendations. He has done a great job stabilizing my vision."
~ Tom, April 2022

"Dr. Pachydacki is great if you need anything for your eyes.
Very good assistants."
Paula, March 2022

"They provide transportation from Wooster to their Canton facility and back;
I am seen promptly even when I'm a half hour early for my appointment; everybody is so professional, courteous and respectful. And the treatments are improving my eye condition which I was beginning to doubt since the treatments at Wooster seemed to have no good effect."
~ Allan, March 2022