Collaborative care

Patient Referral

Connect with Our Specialists

Refer to Buffalo Ophthalmology

Thank you for trusting us with your patient’s care. To refer a patient to one of our specialists, please complete the referral form below. Once submitted, our team will follow up to coordinate the next steps and ensure a smooth, collaborative experience.

Call: (716) 633-7386

Request Appointment

Thanks for contacting us! We will get in touch with you shortly.

Today's Date *

Day

Month

Year

Doctor's Name *

First

Last

Phone (Main) *

Email Address *

Doctor's Address *

Street Address

City

State

Zip

Preferred Method of Communication *

Email

Phone

Fax

Patient's Name *

First

Last

Phone (Main) *

Date Of Birth *

Day

Month

Year

Reason for Referral *

Treatment Plan *

Additional Information

Have Questions About Referrals?

If you need assistance or would like to speak directly with one of our specialists before submitting a referral, please don’t hesitate to contact our team. We’re here to support you and ensure your patient receives expert care.

Call: (716) 633-7386

Request Appointment