Urgency of referral

Urgent <24-48hrs

<2 weeks

Next available

Patient information

Date of birth *

Referrer's Information

Cataract/Refractive Surgery

Refractive outcome preferable:

Distance (Monofocal/Toric IOL)

Near vision

Monovision

Requires further discussion with surgeon

Retinal

Diabetic Eye review

Macular Degeneration

Artery/Vein Occlusion

Flashes and Floaters

Cornea Management

Abrasion/Ulcer

Keratoconus/ectasia

Pterygium

Fuchs’ dystrophy / cornea dystrophy

Foreign body

Glaucoma Assessment

Narrow angle

Raised IOP

Suspicious ONH or C/D asymmetry

Visual Field defect

Laser Rx (iridotomy/SLT)

IOP