Patient Referral Form

Thank you for trusting RCH.

Over 2,000 doctors refer their patients to Retina Consultants of Houston from the Houston area, and from around the world. We love what we do, and look forward to providing you and your patients with exceptional care and support. Please use the referral form below to get started.

Urgent Requests

For urgent requests, please call 713-524-3434

Insurance Plans

We accept all major insurance plans

PDF Referral Forms

If you prefer, you can download a form and fax it over.

PDF Referral Form

Thank You!

We appreciate your trust, and thank you for your partnership.

Thanks from RCH

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